Provider Demographics
NPI:1104621879
Name:VAUGHAN, KAITLIN NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:NICOLE
Last Name:VAUGHAN
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:VAUGHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:699 COUNTY ROAD 558
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65609-8051
Mailing Address - Country:US
Mailing Address - Phone:636-697-5745
Mailing Address - Fax:
Practice Address - Street 1:366 COUNTRY MEADOW LN
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-5278
Practice Address - Country:US
Practice Address - Phone:573-642-7216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025008447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist