MEDICARE: JENNIFER DEVAUGHN CRNP-PMH

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	R203373	MD

General Provider Information

NPI Number	:	1467152033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DEVAUGHN CRNP-PMH

Provider Business Mailing Address
First Line	:	327 OAKWAY CT
Second Line	:
City	:	JOPPA
State	:	MD
Zip	:	21085-4740
Country	:	US
Telephone Number	:	410-459-3451
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 MILLTOWN RD
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19808-2227
Country	:	US
Telephone Number	:	888-517-2088
Fax Number	:

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

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	03/03/2023

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