Provider Demographics
NPI:1891328753
Name:VAUGHN, KATHERINA DENICE (LVN)
Entity Type:Individual
Prefix:
First Name:KATHERINA
Middle Name:DENICE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 S BECKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1903
Mailing Address - Country:US
Mailing Address - Phone:903-534-4684
Mailing Address - Fax:
Practice Address - Street 1:205 PARKER ST.
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:TX
Practice Address - Zip Code:76635
Practice Address - Country:US
Practice Address - Phone:254-420-9439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180830164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse