Provider Demographics
NPI:1912358565
Name:VAUGHAN, MELEAH (NP)
Entity Type:Individual
Prefix:
First Name:MELEAH
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MELEAH
Other - Middle Name:
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:619 E MASON ST
Mailing Address - Street 2:SUITE 4P57
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62701-1034
Mailing Address - Country:US
Mailing Address - Phone:217-788-0706
Mailing Address - Fax:217-525-2535
Practice Address - Street 1:9229 WARD PKWY STE 380
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-5471
Practice Address - Country:US
Practice Address - Phone:816-319-4785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014382363LA2100X
MOMO-2013039537363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01684868OtherRAILROAD
ILP01684868OtherRAILROAD
ILF400308151Medicare PIN