Provider Demographics
NPI:1558686691
Name:VAUGHAN, ANNE T (APRN)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:T
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2401 TERRA CROSSING BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5371
Mailing Address - Country:US
Mailing Address - Phone:502-225-4480
Mailing Address - Fax:502-225-9169
Practice Address - Street 1:100 E LIBERTY ST
Practice Address - Street 2:SUITE 800
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1434
Practice Address - Country:US
Practice Address - Phone:502-225-4480
Practice Address - Fax:502-225-9169
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3006283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0000000897412OtherANTHEM
KY7100272350Medicaid
KYK117691Medicare PIN