Healthcare Provider Details

I. General information

NPI: 1053258400
Provider Name (Legal Business Name): TAMMY VAUGHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 NEW HOPE ROAD EXT
WINONA MS
38967-9517
US

IV. Provider business mailing address

42 NEW HOPE ROAD EXT
WINONA MS
38967-9517
US

V. Phone/Fax

Practice location:
  • Phone: 662-417-6803
  • Fax:
Mailing address:
  • Phone: 228-231-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: