MEDICARE: JADA D. VAUGHAN PH.D.

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
1	103TC0700X	Clinical Psychologist	PY10390	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043283633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADA D. VAUGHAN PH.D.

Provider Business Mailing Address
First Line	:	4544 HIGHWAY 157
Second Line	:
City	:	JUDSONIA
State	:	AR
Zip	:	72081-9138
Country	:	US
Telephone Number	:	501-728-2262
Fax Number	:

Provider Business Practice Location Address
First Line	:	1024 WILLA SPRINGS DR
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-5214
Country	:	US
Telephone Number	:	561-790-1191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	06/25/2019

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