Healthcare Provider Details

I. General information

NPI: 1831238716
Provider Name (Legal Business Name): BETTY CAROL VAUGHAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 NEWTOWN PIKE
LEXINGTON KY
40508-1113
US

IV. Provider business mailing address

3109 GRANTHAM WAY
LEXINGTON KY
40509-2373
US

V. Phone/Fax

Practice location:
  • Phone: 859-252-2371
  • Fax:
Mailing address:
  • Phone: 859-263-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number1022956
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: