Provider Demographics
NPI:1316419518
Name:VAUGHAN, MARY GRACE ARCE (FNP-C)
Entity type:Individual
Prefix:
First Name:MARY GRACE
Middle Name:ARCE
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARY GRACE
Other - Middle Name:IGNACIO
Other - Last Name:ARCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1130 PECAN DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5774
Mailing Address - Country:US
Mailing Address - Phone:817-341-2520
Mailing Address - Fax:
Practice Address - Street 1:1130 PECAN DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5774
Practice Address - Country:US
Practice Address - Phone:817-341-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145564363LF0000X
DEL1-0045218163W00000X
DELG-0001218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse