Healthcare Provider Details

I. General information

NPI: 1336303080
Provider Name (Legal Business Name): LISA ANITA VAUGHN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OPELOUSAS STREET
LAKE CHARLES LA
70601
US

IV. Provider business mailing address

2000 OPELOUSAS STREET
LAKE CHARLES LA
70601
US

V. Phone/Fax

Practice location:
  • Phone: 337-439-9983
  • Fax: 337-439-3224
Mailing address:
  • Phone: 337-439-9983
  • Fax: 337-439-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO.000138
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberDO.000138
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: