Healthcare Provider Details

I. General information

NPI: 1568637817
Provider Name (Legal Business Name): MS. LANA SUE VAUGHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LANA SUE VAUGHN COTA

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 MERCER LN
BISMARCK AR
71929-7251
US

IV. Provider business mailing address

218 MERCER LN
BISMARCK AR
71929-7251
US

V. Phone/Fax

Practice location:
  • Phone: 501-865-3141
  • Fax:
Mailing address:
  • Phone: 501-665-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: