Provider Demographics
NPI:1356474167
Name:VAUGHN, BILLY J (LPN)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:J
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:MO
Mailing Address - Zip Code:65355-0280
Mailing Address - Country:US
Mailing Address - Phone:660-438-8850
Mailing Address - Fax:660-438-3451
Practice Address - Street 1:802 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3044
Practice Address - Country:US
Practice Address - Phone:660-438-8850
Practice Address - Fax:660-438-3451
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042211164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse