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NPI Code Detail

MEDICARE: MRS. ANGELA DALE VAUGHN MS, RD, LD

MEDICARE: MRS. ANGELA DALE VAUGHN MS, RD, LD
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
1133V00000XRegistered Dietitian726AR

General Provider Information

NPI Number : 1629114756
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANGELA DALE VAUGHN MS, RD, LD
Provider Business Mailing Address
First Line : 1001 SCHNEIDER DR
Second Line :
City : MALVERN
State : AR
Zip : 72104-4811
Country : US
Telephone Number : 507-332-1064
Fax Number : 501-332-7054
Provider Business Practice Location Address
First Line : 806 GLENDALE ST
Second Line :
City : JONESBORO
State : AR
Zip : 72401-4455
Country : US
Telephone Number : 870-933-9528
Fax Number : 870-933-9778
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 12/10/2019

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