Provider Demographics
NPI:1790035731
Name:VAUGHAN, CHARLENE LUECINDA (NP)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:LUECINDA
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:VAUGHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:111 ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-5220
Mailing Address - Country:US
Mailing Address - Phone:662-570-4636
Mailing Address - Fax:662-798-0191
Practice Address - Street 1:111 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5220
Practice Address - Country:US
Practice Address - Phone:662-570-4636
Practice Address - Fax:662-798-0191
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR778046363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily