Provider Demographics
NPI:1740059278
Name:VAUGHN, SHERRY (NP)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 MASON RIDGE CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8512
Mailing Address - Country:US
Mailing Address - Phone:314-448-3791
Mailing Address - Fax:
Practice Address - Street 1:2630 HIGHWAY K STE 100
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-6624
Practice Address - Country:US
Practice Address - Phone:636-240-5454
Practice Address - Fax:636-980-5335
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2017026685163WM0705X
MO2024006643363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical