Doctor Name: | PATRICIA M VAUGHN-GOODMAN |
NPI Number: | 1669466074 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 1951 |
Business Practice Address: | 103 Little Mountain Rd Ninety Six, SC - 296669252 |
Business Phone Number: | 8645433515 |
Business Fax Number: | 8645432973 |
Mailing Address: | 103 Little Mountain Rd, NINETY SIX |
State: | SC |
Postal Code: | 296669252 |
Phone Number: | 8645433515 |
Fax Number: | 8645432973 |
NPI Enumeration Date: | 08/31/2005 |
NPI Last Update Date: | 07/01/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 1951 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |