Healthcare Provider Details

I. General information

NPI: 1487323564
Provider Name (Legal Business Name): STEVEN LEE VAUGHN PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W MAIN ST STE M
JENKS OK
74037-3553
US

IV. Provider business mailing address

6511 E 86TH PL
TULSA OK
74133-4120
US

V. Phone/Fax

Practice location:
  • Phone: 918-701-0190
  • Fax:
Mailing address:
  • Phone: 918-701-0190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: