Provider Demographics
NPI:1841745643
Name:VAUGHN, SHAE LAVON (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHAE
Middle Name:LAVON
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:SHAE
Other - Middle Name:LAVON
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:309 LAKE RD STE A
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-1513
Practice Address - Country:US
Practice Address - Phone:254-933-5600
Practice Address - Fax:254-933-5605
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131984363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily