Provider Demographics
NPI:1891433124
Name:VAUGHN, AMY LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:VAUGHN
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 1:214 SPRING VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-5335
Mailing Address - Country:US
Mailing Address - Phone:870-307-9483
Mailing Address - Fax:
Practice Address - Street 1:214 SPRING VALLEY DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-5335
Practice Address - Country:US
Practice Address - Phone:870-307-9483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR219565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR219565OtherARKANSAS STATE BOARD OF NURSING