Provider Demographics
NPI:1023618337
Name:VAUGHN, JOHN DAVID
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 S OAKWOOD AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-5955
Mailing Address - Country:US
Mailing Address - Phone:681-222-4609
Mailing Address - Fax:
Practice Address - Street 1:713 S OAKWOOD AVE APT 201
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-5955
Practice Address - Country:US
Practice Address - Phone:681-222-4609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant