Healthcare Provider Details

I. General information

NPI: 1285547125
Provider Name (Legal Business Name): CHARLTON KEITH VAUGHN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 RALSTON RD STE 1BE
ARVADA CO
80004-4974
US

IV. Provider business mailing address

12058 E VIRGINIA PL
AURORA CO
80012-2261
US

V. Phone/Fax

Practice location:
  • Phone: 720-336-1530
  • Fax:
Mailing address:
  • Phone: 720-336-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: