Provider Demographics
NPI:1316089519
Name:VAUGHAN, LYNN A (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:989 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-1232
Mailing Address - Country:US
Mailing Address - Phone:913-727-2874
Mailing Address - Fax:
Practice Address - Street 1:920 6TH AVE
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-3225
Practice Address - Country:US
Practice Address - Phone:913-682-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS27598207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS4027819OtherAETNA PROVIDER #
KS0300427OtherUNITED HEALTHCARE
KS27598OtherSTATE LICENSE
KS30809019OtherBCBS OF KANSAS CITY
KS102093OtherBLUE CROSS BLUE SHIELD KS
KS102093OtherBLUE CROSS BLUE SHIELD KS
KS30809019OtherBCBS OF KANSAS CITY