MEDICARE: JORDAN TAYLOR VAUGHAN AUD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	231H00000X	Audiologist	201373	AR

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	:	1750962700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN TAYLOR VAUGHAN AUD

Provider Business Mailing Address
First Line	:	4300 W. 7TH ST.
Second Line	:	ATTN: 126/LR
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-4832
Country	:	US
Telephone Number	:	501-257-1085
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 W. 7TH ST.
Second Line	:	ATTN: 126/LR
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-4832
Country	:	US
Telephone Number	:	501-257-1085
Fax Number	:

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

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	06/03/2024

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