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NPI Code Detail

MEDICARE: JASON CHRISTOPHER VAUGHN NP

MEDICARE: JASON CHRISTOPHER VAUGHN NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner5010993NC

General Provider Information

NPI Number : 1033693932
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON CHRISTOPHER VAUGHN NP
Provider Business Mailing Address
First Line : 207 E MEADOW RD STE 6
Second Line :
City : EDEN
State : NC
Zip : 27288-3469
Country : US
Telephone Number : 336-864-2795
Fax Number : 336-864-2895
Provider Business Practice Location Address
First Line : 2645 MERIDIAN PKWY STE 323
Second Line :
City : DURHAM
State : NC
Zip : 27713-4232
Country : US
Telephone Number : 984-227-8902
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2018
Last Update Date : 12/31/2020

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