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General NPI Number Information
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NPI Number | 1467317073
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Entity Type | Individual
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Provider Name | CASIE DIANE VAUGHN
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Gender | Female
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 217 S PRUETT ST
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City | PARAGOULD
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State | AR
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Zip | 72450-4331
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Country | US
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Telephone | 870-450-2491
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Fax |
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Provider Business Mailing Address
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Address Line | 3204 RED OAK DR
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City | PARAGOULD
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State | AR
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Zip | 72450-3937
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Country | US
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Telephone | 870-450-2123
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 1616920
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License Number State | AR
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