Provider Demographics
NPI:1922713270
Name:VAUGHN, REAGAN HARDIN (PA-C)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:HARDIN
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REAGAN
Other - Middle Name:LORAINE
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 W LEAKE ST APT B
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056
Mailing Address - Country:US
Mailing Address - Phone:662-414-6729
Mailing Address - Fax:
Practice Address - Street 1:1860 CHADWICK DRIVE #254
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204
Practice Address - Country:US
Practice Address - Phone:601-376-2818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant