Provider Demographics
NPI:1558990531
Name:VAUGHAN, JESSICA (BSN, RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7359 BROOKVILLE SALEM RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-9205
Mailing Address - Country:US
Mailing Address - Phone:937-823-9405
Mailing Address - Fax:
Practice Address - Street 1:7359 BROOKVILLE SALEM RD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-9205
Practice Address - Country:US
Practice Address - Phone:937-823-9405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.395321163WA2000X, 163WC0400X, 163WC1600X, 163WC2100X, 163WD0400X, 163WE0900X, 163WG0000X, 163WG0100X, 163WH0200X, 163WN1003X, 163WP0000X, 163WR0400X, 163WW0000X, 163WX1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care