Provider Demographics
NPI:1780361469
Name:VAUGHAN, JENNIFER KRISTEN (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KRISTEN
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KRISTEN COLE
Other - Last Name:VAUGHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:212 KROGER WAY
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1991
Mailing Address - Country:US
Mailing Address - Phone:859-297-1072
Mailing Address - Fax:
Practice Address - Street 1:212 KROGER WAY
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1991
Practice Address - Country:US
Practice Address - Phone:857-297-1072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4005971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily