MEDICARE: MRS. KATHY LEIGH VAUGHN CRNP

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	1-094408	AL

General Provider Information

NPI Number	:	1265662183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHY LEIGH VAUGHN CRNP

Provider Business Mailing Address
First Line	:	PO BOX 1049
Second Line	:
City	:	BOAZ
State	:	AL
Zip	:	35957-2201
Country	:	US
Telephone Number	:	256-593-9999
Fax Number	:	256-593-9141

Provider Business Practice Location Address
First Line	:	1180 SARDIS DR
Second Line	:
City	:	BOAZ
State	:	AL
Zip	:	35956-2139
Country	:	US
Telephone Number	:	256-593-9999
Fax Number	:	256-593-9141

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

Provider Enumeration Date	:	07/27/2009
Last Update Date	:	07/27/2009

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