MEDICARE: NEENAH JOLLY VAUGHN NP

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	363LF0000X	Family Nurse Practitioner	5011788	NC

General Provider Information

NPI Number	:	1639735277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEENAH JOLLY VAUGHN NP

Provider Business Mailing Address
First Line	:	1194 BETHEL CHURCH RD
Second Line	:
City	:	MARION
State	:	NC
Zip	:	28752-6078
Country	:	US
Telephone Number	:	828-289-4741
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 SIPES ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-2716
Country	:	US
Telephone Number	:	828-317-6741
Fax Number	:

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

Provider Enumeration Date	:	05/17/2019
Last Update Date	:	12/05/2025

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