Provider Demographics
NPI:1447787676
Name:JENNA VAUGHT LLC
Entity Type:Organization
Organization Name:JENNA VAUGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PRIVATE PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:VAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:502-438-7739
Mailing Address - Street 1:PO BOX 910216
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0216
Mailing Address - Country:US
Mailing Address - Phone:502-438-7739
Mailing Address - Fax:
Practice Address - Street 1:3407 KERRY DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2131
Practice Address - Country:US
Practice Address - Phone:716-860-9958
Practice Address - Fax:716-860-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1700174604OtherNPI
1447787676OtherNPI2 DRJENNA VAUGHT LLC
KY7100297720Medicaid