Provider Demographics
NPI:1205115318
Name:VAUGHN, KATHERINE C (PNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:C
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 KEYBRIDGE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5915
Mailing Address - Country:US
Mailing Address - Phone:919-677-8577
Mailing Address - Fax:
Practice Address - Street 1:133 KEYBRIDGE DR
Practice Address - Street 2:SUITE C
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-5915
Practice Address - Country:US
Practice Address - Phone:919-677-8577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5000716363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics