Healthcare Provider Details

I. General information

NPI: 1831515113
Provider Name (Legal Business Name): JESSIE VAUGHAN A.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSIE TSAI AA

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7509 MARSHA SHARP FWY
LUBBOCK TX
79407-8202
US

IV. Provider business mailing address

4515 MARSHA SHARP FWY
LUBBOCK TX
79407-2520
US

V. Phone/Fax

Practice location:
  • Phone: 806-744-7223
  • Fax: 806-740-3325
Mailing address:
  • Phone: 806-744-7223
  • Fax: 806-740-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: