Provider Demographics
NPI:1720606361
Name:VAUGHN, KRYSTAL HENLEY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:HENLEY
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-2050
Mailing Address - Fax:704-316-2051
Practice Address - Street 1:6909 PROSPERITY CHURCH RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6698
Practice Address - Country:US
Practice Address - Phone:704-316-2050
Practice Address - Fax:704-316-2051
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013268363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily