Healthcare Provider Details

I. General information

NPI: 1568138741
Provider Name (Legal Business Name): KRISTEN C VAUGHN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN C SPEER

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NW EXPRESSWAY
OKLAHOMA CITY OK
73112-4418
US

IV. Provider business mailing address

3300 NW EXPRESSWAY
OKLAHOMA CITY OK
73112-4418
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-3284
  • Fax:
Mailing address:
  • Phone: 405-949-3284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number47947
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: