MEDICARE: MICHAEL ANN VAUGHN DNP

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	363LP0200X	Pediatric Nurse Practitioner	NUR-APRN-LIC-234789	MT

General Provider Information

NPI Number	:	1538655998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ANN VAUGHN DNP

Provider Business Mailing Address
First Line	:	1001 S MAIN ST # 10489
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-1498
Country	:	US
Telephone Number	:	406-220-2120
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 S MAIN ST # 10489
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-1498
Country	:	US
Telephone Number	:	406-220-2120
Fax Number	:

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

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	11/13/2025

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