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General NPI Number Information
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NPI Number | 1801147160
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Entity Type | Individual
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Provider Name | VICKEY LYNN VAUGHAN NP
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Gender | Female
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Dates
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Enumeration Date | 09/27/2012
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Last Update Date | 09/27/2012
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Provider Practice Location Address
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Address Line | 351 W CAMDEN ST THE WAREHOUSE AT CAMDEN YARDS SUITE 100
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City | BALTIMORE
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State | MD
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Zip | 21201-7912
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Country | US
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Telephone | 410-735-8751
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Fax |
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Provider Business Mailing Address
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Address Line | 591 CHAPPELL MILL RD
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City | MILNER
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State | GA
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Zip | 30257-3328
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Country | US
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Telephone | 770-789-4462
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RNO51617
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License Number State | GA
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