Provider Demographics
NPI:1386489789
Name:VAUGHN, RYNE GAGE (RDN)
Entity type:Individual
Prefix:MR
First Name:RYNE
Middle Name:GAGE
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 ALBANY LN
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4772
Mailing Address - Country:US
Mailing Address - Phone:806-632-7976
Mailing Address - Fax:
Practice Address - Street 1:1924 ALBANY LN
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4772
Practice Address - Country:US
Practice Address - Phone:806-632-7976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87937133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered