Provider Demographics
NPI:1578660791
Name:YOLANDA HUET-VAUGHN, M.D., P.A.
Entity Type:Organization
Organization Name:YOLANDA HUET-VAUGHN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUET-VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-262-0550
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:913-831-3048
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
Practice Address - Country:US
Practice Address - Phone:913-262-0550
Practice Address - Fax:913-831-3048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200251440AMedicaid
C50433Medicare UPIN
KS200251440AMedicaid
DC9964Medicare ID - Type UnspecifiedMEDICARE - RAILROAD
MOR160000AMedicare ID - Type UnspecifiedMEDICARE - JACKSON CO.