MEDICARE: KEYMONNI A VAUGHN

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1962966994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEYMONNI A VAUGHN

Provider Business Mailing Address
First Line	:	2804 MARLIN AVE APT D
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-4712
Country	:	US
Telephone Number	:	702-249-6946
Fax Number	:

Provider Business Practice Location Address
First Line	:	2804 MARLIN AVE APT D
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-4712
Country	:	US
Telephone Number	:	702-249-6946
Fax Number	:

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

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	01/23/2019

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Directions to “ KEYMONNI A VAUGHN ” Practice Location

Language	Start Address	Practice Location

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