Provider Demographics
NPI:1801629266
Name:DEVAUGHN, MYSHELL B
Entity type:Individual
Prefix:
First Name:MYSHELL
Middle Name:B
Last Name:DEVAUGHN
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 1:10829 ORNELLA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3513
Mailing Address - Country:US
Mailing Address - Phone:725-308-7138
Mailing Address - Fax:
Practice Address - Street 1:10829 ORNELLA ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-3513
Practice Address - Country:US
Practice Address - Phone:725-308-7138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant