Provider Demographics
NPI:1497271076
Name:VAUGHN, KENDAL MARIE (IBCLC, RN)
Entity Type:Individual
Prefix:MRS
First Name:KENDAL
Middle Name:MARIE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:IBCLC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32835A MAGNOLIA FARMS RD
Mailing Address - Street 2:
Mailing Address - City:ROBERTSDALE
Mailing Address - State:AL
Mailing Address - Zip Code:36567-9373
Mailing Address - Country:US
Mailing Address - Phone:850-390-6896
Mailing Address - Fax:
Practice Address - Street 1:2475 E NINE MILE RD STE E
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7796
Practice Address - Country:US
Practice Address - Phone:850-390-6896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9341464163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$OtherPRIVATE INS