MEDICARE: KYLE VAUGHN PA-C

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	363AM0700X	Medical Physician Assistant	0010-07079	NC
2	363AM0700X	Medical Physician Assistant	0110007161	VA

General Provider Information

NPI Number	:	1841739141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE VAUGHN PA-C

Provider Business Mailing Address
First Line	:	4445 CORPORATION LN STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3666
Country	:	US
Telephone Number	:	757-623-0005
Fax Number	:	757-548-1128

Provider Business Practice Location Address
First Line	:	814 KEMPSVILLE RD STE 102
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-4001
Country	:	US
Telephone Number	:	757-623-0005
Fax Number	:	757-389-5412

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

Provider Enumeration Date	:	02/20/2017
Last Update Date	:	01/20/2022

Similar Medicare Providers

1396742037 — ABDUL W CHAUDHRY M.D.
Practice Location Address:

814 KEMPSVILLE RD , SUITE 102 BLDG 17
NORFOLK, VA
23502-4001

Practice Phone: 757-623-0005
Practice Fax: 757-389-5412

1205834405 — WEI D. ZHAO M.D.
Practice Location Address:

814 KEMPSVILLE RD , SUITE 102 BLDG 17
NORFOLK, VA
23502-4001

Practice Phone: 757-623-0005
Practice Fax: 757-389-5412

1649345372 — RONALD E NAVE PA
Practice Location Address:

814 KEMPSVILLE RD STE 104
NORFOLK, VA
23502-4001

Practice Phone: 757-455-8887
Practice Fax:

1104988328 — BRIAN SHANKLIN WEAVER MD
Practice Location Address:

814 KEMPSVILLE RD , SUITE 104
NORFOLK, VA
23502-4001

Practice Phone: 757-455-8887
Practice Fax:

1053678839 — TIDEWATER KIDNEY SPECIALISTS, INC.
Practice Location Address:

814 KEMPSVILLE RD , SUITE 101
NORFOLK, VA
23502-4001

Practice Phone: 757-623-0005
Practice Fax: 757-548-1129

1932569837 — LESLIE OLIVIER
Practice Location Address:

814 KEMPSVILLE RD , SUITE 104
NORFOLK, VA
23502-4001

Practice Phone: 757-455-8887
Practice Fax:

Directions to “ KYLE VAUGHN PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.