1578983235 NPI number — MRS. HEATHER ELAINE VAUGHN FNP

Table of content: MRS. HEATHER ELAINE VAUGHN FNP (NPI 1578983235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578983235 NPI number — MRS. HEATHER ELAINE VAUGHN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAUGHN
Provider First Name:
HEATHER
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FATHEREE
Provider Other First Name:
HEATHER
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578983235
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 W BELKNAP ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSBORO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76458-2386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-567-8114
Provider Business Mailing Address Fax Number:
940-784-2216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 W BELKNAP ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSBORO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76458-2386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-567-8114
Provider Business Practice Location Address Fax Number:
940-784-2216
Provider Enumeration Date:
04/22/2014

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: 363LF0000X , with the licence number:  679706 , 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)





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