Provider Demographics
NPI:1972199750
Name:VAUGHN, VALERIE (RN, MSN, APRN, CNM)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:RN, MSN, APRN, CNM
Other - Prefix:
Other - First Name:NGENUE
Other - Middle Name:
Other - Last Name:ASOBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 DERBY LN
Mailing Address - Street 2:
Mailing Address - City:HICKORY CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:75065-0347
Mailing Address - Country:US
Mailing Address - Phone:214-440-9903
Mailing Address - Fax:
Practice Address - Street 1:622 HEMPHILL ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3179
Practice Address - Country:US
Practice Address - Phone:817-878-2737
Practice Address - Fax:817-878-2735
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1022181367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife