1972199750 NPI number — VALERIE VAUGHN RN, MSN, APRN, CNM

Table of content: DR. JONATHAN G GARRETSON O.D. (NPI 1992885578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972199750 NPI number — VALERIE VAUGHN RN, MSN, APRN, CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAUGHN
Provider First Name:
VALERIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, APRN, CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ASOBO
Provider Other First Name:
NGENUE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972199750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 DERBY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKORY CREEK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75065-0347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-440-9903
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
622 HEMPHILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-3179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-878-2737
Provider Business Practice Location Address Fax Number:
817-878-2735
Provider Enumeration Date:
12/16/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  1022181 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com