Healthcare Provider Details

I. General information

NPI: 1285339218
Provider Name (Legal Business Name): NYKEISHA VAUGHN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 TUTOR LN STE 107
EVANSVILLE IN
47715-7295
US

IV. Provider business mailing address

1923 S LIBERTY DR
BLOOMINGTON IN
47403-5146
US

V. Phone/Fax

Practice location:
  • Phone: 812-602-1038
  • Fax: 812-602-1048
Mailing address:
  • Phone: 812-602-1038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-244200
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: