Provider Demographics
NPI:1598044703
Name:VAUGHN, KATELYN (ANP-BC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:SPADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:99 EAGLE TRCE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-3443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-4603
Practice Address - Country:US
Practice Address - Phone:617-973-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2023-12-05
Deactivation Date:2022-08-10
Deactivation Code:
Reactivation Date:2023-12-05
Provider Licenses
StateLicense IDTaxonomies
MARN2264261363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health