Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP3147 | AZ |
NPI | 1003068727 |
---|---|
Provider Name | Miss Kimara Vaughn |
First Address | Phoenix, AZ 85032-2236 |
Second Address | Phoenix, AZ 85008-6088 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2008 |
Last Update Date | 08/03/2016 |