Healthcare Provider Details

I. General information

NPI: 1194796987
Provider Name (Legal Business Name): DONALD D VAUGHN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/02/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4222 BELL RD STE 5
NEWBURGH IN
47630-2541
US

IV. Provider business mailing address

PO BOX 28227
BELFAST ME
04915-2034
US

V. Phone/Fax

Practice location:
  • Phone: 812-758-3032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15880
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007878A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: