Healthcare Provider Details

I. General information

NPI: 1578396784
Provider Name (Legal Business Name): GARRETT VAUGHN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S AVENUE A
YUMA AZ
85364-7170
US

IV. Provider business mailing address

7051 E KESSLER AVE
MESA AZ
85209-4082
US

V. Phone/Fax

Practice location:
  • Phone: 928-336-2000
  • Fax:
Mailing address:
  • Phone: 480-228-3985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10498
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10498
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: