MEDICARE: MRS. KALEY VAUGHAN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	5321	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538532692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KALEY VAUGHAN PA-C

Provider Business Mailing Address
First Line	:	5500 FRONT ST STE 250
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29486-8140
Country	:	US
Telephone Number	:	850-516-4070
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 FRONT ST STE 250
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29486-8140
Country	:	US
Telephone Number	:	843-278-8474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2015
Last Update Date	:	07/18/2025

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