Healthcare Provider Details

I. General information

NPI: 1245852474
Provider Name (Legal Business Name): MELISSA DIANE VAUGHT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 LEXINGTON RD
GEORGETOWN KY
40324-9330
US

IV. Provider business mailing address

283 ARTHUR CT
HARRODSBURG KY
40330-8717
US

V. Phone/Fax

Practice location:
  • Phone: 502-868-1100
  • Fax:
Mailing address:
  • Phone: 859-753-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number56951
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: