Provider Demographics
NPI:1821478785
Name:VAUGHN, JENNIFER WHATLEY (PT)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:WHATLEY
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 WESTBANK EXPY
Mailing Address - Street 2:SUITE D
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2354
Mailing Address - Country:US
Mailing Address - Phone:504-371-4226
Mailing Address - Fax:
Practice Address - Street 1:703 CLINTON PKWY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5245
Practice Address - Country:US
Practice Address - Phone:601-708-4205
Practice Address - Fax:601-708-4707
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist