Provider Demographics
NPI:1669466074
Name:VAUGHN-GOODMAN, PATRICIA M (APRN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:VAUGHN-GOODMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 LITTLE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NINETY SIX
Mailing Address - State:SC
Mailing Address - Zip Code:29666-9252
Mailing Address - Country:US
Mailing Address - Phone:864-543-3515
Mailing Address - Fax:864-543-2973
Practice Address - Street 1:103 LITTLE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NINETY SIX
Practice Address - State:SC
Practice Address - Zip Code:29666-9252
Practice Address - Country:US
Practice Address - Phone:864-543-3515
Practice Address - Fax:864-543-2973
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0741Medicaid
SCQ04964Medicare UPIN
SCNP0741Medicaid