Provider Demographics
NPI:1154340982
Name:JOHNSON VAUGHT, L DENISE (NP)
Entity type:Individual
Prefix:MRS
First Name:L
Middle Name:DENISE
Last Name:JOHNSON VAUGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 HARBORSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:KEMAH
Mailing Address - State:TX
Mailing Address - Zip Code:77565-2252
Mailing Address - Country:US
Mailing Address - Phone:281-745-7276
Mailing Address - Fax:
Practice Address - Street 1:500 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4220
Practice Address - Country:US
Practice Address - Phone:281-338-3708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657031363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142133111Medicaid
TX8Y1578OtherBCBSTX PROVIDER NO.
TX1154340982OtherTRICARE SOUTH
TX142133110Medicaid
TX8K2749Medicare PIN
TXP19412Medicare UPIN
TX8Y1578OtherBCBSTX PROVIDER NO.