Healthcare Provider Details

I. General information

NPI: 1417686262
Provider Name (Legal Business Name): EMILY VAUGHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 AIRPORT RD STE B
HOT SPRINGS AR
71913-8069
US

IV. Provider business mailing address

1661 AIRPORT RD STE D
HOT SPRINGS AR
71913-8184
US

V. Phone/Fax

Practice location:
  • Phone: 501-767-0075
  • Fax:
Mailing address:
  • Phone: 501-625-7500
  • Fax: 501-625-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: