MEDICARE: LESLIE NICOLE VAUGHAN

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	236296	AR

General Provider Information

NPI Number	:	1225983604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE NICOLE VAUGHAN

Provider Business Mailing Address
First Line	:	430 MAGNOLIA RD
Second Line	:
City	:	CAMDEN
State	:	AR
Zip	:	71701-4146
Country	:	US
Telephone Number	:	870-836-5709
Fax Number	:	870-836-5837

Provider Business Practice Location Address
First Line	:	430 MAGNOLIA RD
Second Line	:
City	:	CAMDEN
State	:	AR
Zip	:	71701-4146
Country	:	US
Telephone Number	:	870-836-5709
Fax Number	:	870-836-5837

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ LESLIE NICOLE VAUGHAN ” Practice Location

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