Healthcare Provider Details

I. General information

NPI: 1902273816
Provider Name (Legal Business Name): KATHERINE VAUGHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 CAMPBELL LN
YERINGTON NV
89447-9768
US

IV. Provider business mailing address

171 CAMPBELL LN
YERINGTON NV
89447-9768
US

V. Phone/Fax

Practice location:
  • Phone: 775-463-3335
  • Fax: 775-463-2709
Mailing address:
  • Phone: 775-463-3335
  • Fax: 775-463-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN27458
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: