Provider Demographics
NPI:1457846446
Name:VAUGHN, KAREN PAGE (CAREGIVER)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:PAGE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:PAGE
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAREGIVER
Mailing Address - Street 1:24503 BELL CANYON LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4497
Mailing Address - Country:US
Mailing Address - Phone:281-636-4389
Mailing Address - Fax:
Practice Address - Street 1:24503 BELL CANYON LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4497
Practice Address - Country:US
Practice Address - Phone:281-636-4389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX$$$$$$$$$Medicaid