Healthcare Provider Details

I. General information

NPI: 1194577726
Provider Name (Legal Business Name): T'KEYAH VAUGHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 07/06/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N 2ND ST FL 3
RICHMOND VA
23219-1359
US

IV. Provider business mailing address

PO BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-7912
  • Fax: 804-828-9283
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0116039259
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: