Provider Demographics
NPI:1164646824
Name:VAUGHAN, JUDI ANN
Entity type:Individual
Prefix:MRS
First Name:JUDI
Middle Name:ANN
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 BELFONTE ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-1317
Mailing Address - Country:US
Mailing Address - Phone:606-836-0683
Mailing Address - Fax:
Practice Address - Street 1:316 MARION PIKE
Practice Address - Street 2:
Practice Address - City:COAL GROVE
Practice Address - State:OH
Practice Address - Zip Code:45638-2957
Practice Address - Country:US
Practice Address - Phone:740-532-6143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2421025372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider