Healthcare Provider Details

I. General information

NPI: 1467317073
Provider Name (Legal Business Name): CASIE DIANE VAUGHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 S PRUETT ST
PARAGOULD AR
72450-4331
US

IV. Provider business mailing address

3204 RED OAK DR
PARAGOULD AR
72450-3937
US

V. Phone/Fax

Practice location:
  • Phone: 870-450-2491
  • Fax:
Mailing address:
  • Phone: 870-450-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1616920
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: