Healthcare Provider Details

I. General information

NPI: 1770428948
Provider Name (Legal Business Name): KRISTY O'LAUGHLIN MAUGHAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTY RAY O'LAUGHLIN RN

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 N MERIDIAN
RUPERT ID
83350-9112
US

IV. Provider business mailing address

238 N MERIDIAN
RUPERT ID
83350-9112
US

V. Phone/Fax

Practice location:
  • Phone: 864-280-5165
  • Fax:
Mailing address:
  • Phone: 864-280-5165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number67634
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: