Provider Demographics
NPI:1043931736
Name:VAUGHN, KELSEY (RN)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:DAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-0803
Mailing Address - Country:US
Mailing Address - Phone:812-361-2551
Mailing Address - Fax:
Practice Address - Street 1:5725 W VINCA LN
Practice Address - Street 2:
Practice Address - City:ELLETTSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47429-9568
Practice Address - Country:US
Practice Address - Phone:812-361-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28210388A163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health