Provider Demographics
NPI:1063876845
Name:VAUGHAN, KRISTEN A
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:MCFALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3686 GRANDVIEW PKWY STE 800
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3408
Mailing Address - Country:US
Mailing Address - Phone:205-858-0900
Mailing Address - Fax:
Practice Address - Street 1:3686 GRANDVIEW PKWY STE 800
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3408
Practice Address - Country:US
Practice Address - Phone:205-858-0900
Practice Address - Fax:205-858-0901
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA323578207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program