Provider Demographics
NPI:1003068727
Name:VAUGHN, KIMARA (APRN-BC)
Entity type:Individual
Prefix:MISS
First Name:KIMARA
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 E BELL RD STE 45348
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2308
Mailing Address - Country:US
Mailing Address - Phone:602-670-4265
Mailing Address - Fax:480-781-4841
Practice Address - Street 1:9700 N 91ST ST STE A115
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5036
Practice Address - Country:US
Practice Address - Phone:602-670-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16-1560175F00000X
AZAP3147363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty