MEDICARE: HOLLY VAUGHN

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	225100000X	Physical Therapist	11-03661	KS
2	225100000X	Physical Therapist	2006032398	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11-03661	OTHER	KS	PT LICENSE NUMBER
2	2006032398	OTHER	MO	PT LICENSE NUMBER

General Provider Information

NPI Number	:	1346367737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY VAUGHN

Provider Business Mailing Address
First Line	:	6124 N MERSINGTON AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-1944
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9223 NE HIGHWAY 152
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64158-7608
Country	:	US
Telephone Number	:	816-792-2266
Fax Number	:

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	09/25/2024

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Directions to “ HOLLY VAUGHN ” Practice Location

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