Provider Demographics
NPI:1245705698
Name:VAUGHN, KELLIE (CRNP)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 NARROWS DR STE 105
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-8663
Mailing Address - Country:US
Mailing Address - Phone:205-407-4150
Mailing Address - Fax:833-517-1881
Practice Address - Street 1:198 NARROWS DR STE 105
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-8663
Practice Address - Country:US
Practice Address - Phone:205-407-4150
Practice Address - Fax:833-517-1881
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-139342363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health