Healthcare Provider Details

I. General information

NPI: 1285547448
Provider Name (Legal Business Name): ASHLEY ELAINE VAUGHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4037 GLOUCESTER RD
ROCKY MOUNT NC
27803-1114
US

IV. Provider business mailing address

4037 GLOUCESTER RD
ROCKY MOUNT NC
27803-1114
US

V. Phone/Fax

Practice location:
  • Phone: 540-958-1713
  • Fax:
Mailing address:
  • Phone: 540-958-1713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number297248
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: