Provider Demographics
NPI:1942295274
Name:VAUGHAN, KARRI ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:KARRI
Middle Name:ELIZABETH
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4373 SILVER VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-8796
Mailing Address - Country:US
Mailing Address - Phone:231-947-0673
Mailing Address - Fax:
Practice Address - Street 1:4624 N SPIDER LAKE RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49696-8440
Practice Address - Country:US
Practice Address - Phone:231-947-0673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N84840001Medicare ID - Type Unspecified
MIB86032033Medicare PIN
MIP90914Medicare UPIN