Provider Demographics
NPI:1770889453
Name:VAUGHN, MOIRA CASTEN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MOIRA
Middle Name:CASTEN
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 N TRADE ST STE 2000-A
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1728
Mailing Address - Country:US
Mailing Address - Phone:704-302-8860
Mailing Address - Fax:
Practice Address - Street 1:332 N TRADE ST STE 2000-A
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1728
Practice Address - Country:US
Practice Address - Phone:704-302-8860
Practice Address - Fax:704-302-8861
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02696363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant