Healthcare Provider Details

I. General information

NPI: 1407793375
Provider Name (Legal Business Name): KELSEY VAUGHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 SOUTH ST
GREENFIELD OH
45123-1249
US

IV. Provider business mailing address

910 SOUTH ST
GREENFIELD OH
45123-1249
US

V. Phone/Fax

Practice location:
  • Phone: 877-997-3224
  • Fax:
Mailing address:
  • Phone: 877-997-3224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: