MEDICARE: DR. JENNIFER WHATLEY VAUGHN PT

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	225100000X	Physical Therapist	09060	LA

General Provider Information

NPI Number	:	1821478785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER WHATLEY VAUGHN PT

Provider Business Mailing Address
First Line	:	7520 WESTBANK EXPY
Second Line	:	SUITE D
City	:	MARRERO
State	:	LA
Zip	:	70072-2354
Country	:	US
Telephone Number	:	504-371-4226
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 CLINTON PKWY
Second Line	:
City	:	CLINTON
State	:	MS
Zip	:	39056-5245
Country	:	US
Telephone Number	:	601-708-4205
Fax Number	:	601-708-4707

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

Provider Enumeration Date	:	06/05/2015
Last Update Date	:	11/06/2019

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