Provider Demographics
NPI:1467543017
Name:HUET-VAUGHN, YOLANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:
Last Name:HUET-VAUGHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 STRONG AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66106-2116
Mailing Address - Country:US
Mailing Address - Phone:913-262-0550
Mailing Address - Fax:913-381-3048
Practice Address - Street 1:3200 STRONG AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66106-2116
Practice Address - Country:US
Practice Address - Phone:913-262-0550
Practice Address - Fax:913-381-3048
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0419814207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS322700OtherFIRST GUARD
MO201368826Medicaid
KS100177750BMedicaid
MO09262071OtherBCBS - KANSAS CITY
KS100177750BMedicaid
MO201368826Medicaid
C50433Medicare UPIN
080153560Medicare ID - Type UnspecifiedMEDICARE - RAILROAD