Provider Demographics
NPI:1366688186
Name:VAUGHT, TAMARA L (APRN, CRNA, PMHNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:L
Last Name:VAUGHT
Suffix:
Gender:F
Credentials:APRN, CRNA, PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 CRESTMONT DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-4237
Mailing Address - Country:US
Mailing Address - Phone:248-506-3584
Mailing Address - Fax:
Practice Address - Street 1:3702 CRESTMONT DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-4237
Practice Address - Country:US
Practice Address - Phone:248-506-3584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1061485363LP0808X
MI4704231142367500000X
TX652148367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health