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General NPI Number Information
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NPI Number | 1821801895
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Entity Type | Individual
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Provider Name | REBECCA VAUGHN PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 2730 CHANNING WAY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7509
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Country | US
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Telephone | 208-542-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 359 N 3RD W APT 303
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City | RIGBY
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State | ID
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Zip | 83442-1146
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Country | US
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Telephone |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9671543
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License Number State | ID
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