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NPI Code Detail

MEDICARE: PATRICIA M VAUGHN-GOODMAN APRN

MEDICARE: PATRICIA M VAUGHN-GOODMAN APRN
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 Practitioner1951SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669466074
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA M VAUGHN-GOODMAN APRN
Provider Business Mailing Address
First Line : 103 LITTLE MOUNTAIN RD
Second Line :
City : NINETY SIX
State : SC
Zip : 29666-9252
Country : US
Telephone Number : 864-543-3515
Fax Number : 864-543-2973
Provider Business Practice Location Address
First Line : 103 LITTLE MOUNTAIN RD
Second Line :
City : NINETY SIX
State : SC
Zip : 29666-9252
Country : US
Telephone Number : 864-543-3515
Fax Number : 864-543-2973
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2005
Last Update Date : 12/14/2021

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