Provider Demographics
NPI:1578983235
Name:VAUGHN, HEATHER ELAINE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ELAINE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:ELAINE
Other - Last Name:FATHEREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:217 W BELKNAP ST
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76458-2386
Mailing Address - Country:US
Mailing Address - Phone:940-567-8114
Mailing Address - Fax:940-784-2216
Practice Address - Street 1:217 W BELKNAP ST
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TX
Practice Address - Zip Code:76458-2386
Practice Address - Country:US
Practice Address - Phone:940-567-8114
Practice Address - Fax:940-784-2216
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX679706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily