MEDICARE: THE PAUSE PRACTICE

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1073471272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PAUSE PRACTICE

Provider Business Mailing Address
First Line	:	2112 BROADWAY ST NE STE 225
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-3081
Country	:	US
Telephone Number	:	612-231-3003
Fax Number	:	774-946-0097

Provider Business Practice Location Address
First Line	:	2112 BROADWAY ST NE STE 225
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-3081
Country	:	US
Telephone Number	:	612-712-7859
Fax Number	:	612-500-4862

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	HEATHER VAUGHN
Credential	:	PMHNP-BC
Telephone Number	:	612-231-3003

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	04/17/2026

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Directions to “THE PAUSE PRACTICE ” Practice Location

Language	Start Address	Practice Location

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