MEDICARE: DONALD D VAUGHN FNP-C

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	363LF0000X	Family Nurse Practitioner	15880	TN
2	363LF0000X	Family Nurse Practitioner	71007878A	IN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194796987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD D VAUGHN FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 28227
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-2034
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4222 BELL RD STE 5
Second Line	:
City	:	NEWBURGH
State	:	IN
Zip	:	47630-2541
Country	:	US
Telephone Number	:	812-758-3032
Fax Number	:

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	10/02/2020

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