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NPI Code Detail

MEDICARE: MRS. KELLI MARIE VAUGHN FNP-BC

MEDICARE: MRS. KELLI MARIE VAUGHN FNP-BC
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
1363LF0000XFamily Nurse Practitioner209009705IL

General Provider Information

NPI Number : 1477800175
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLI MARIE VAUGHN FNP-BC
Provider Business Mailing Address
First Line : 1120 N MELVIN ST
Second Line :
City : GIBSON CITY
State : IL
Zip : 60936-1477
Country : US
Telephone Number : 217-379-4864
Fax Number :
Provider Business Practice Location Address
First Line : 227 N MARKET ST
Second Line :
City : PAXTON
State : IL
Zip : 60957-1123
Country : US
Telephone Number : 217-379-4864
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2012
Last Update Date : 09/22/2020

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Directions to “ MRS. KELLI MARIE VAUGHN FNP-BC” Practice Location

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