Healthcare Provider Details

I. General information

NPI: 1598602864
Provider Name (Legal Business Name): MADISON K VAUGHN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

2548 E KENOSHA ST
BROKEN ARROW OK
74014-6712
US

IV. Provider business mailing address

2510 E 7TH ST APT 4
TULSA OK
74104-3350
US

V. Phone/Fax

Practice location:
  • Phone: 918-355-0993
  • Fax: 918-355-0995
Mailing address:
  • Phone: 918-408-1705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: