Healthcare Provider Details

I. General information

NPI: 1831015296
Provider Name (Legal Business Name): GABRIEL ELLIS VAUGHN MSN, RN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 THOMAS DR
ASHLAND OH
44805-2949
US

IV. Provider business mailing address

998 THOMAS DR
ASHLAND OH
44805-2949
US

V. Phone/Fax

Practice location:
  • Phone: 850-598-6785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0042497
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: