Provider Demographics
NPI:1154929735
Name:VAUGHN-SMITH, VALERIE MICHELLE (APRN,MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:MICHELLE
Last Name:VAUGHN-SMITH
Suffix:
Gender:F
Credentials:APRN,MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 ROCKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-2251
Mailing Address - Country:US
Mailing Address - Phone:903-812-0684
Mailing Address - Fax:
Practice Address - Street 1:3105 ROCKBROOK DR
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-2251
Practice Address - Country:US
Practice Address - Phone:903-812-0684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016663363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty