Provider Demographics
NPI:1699750091
Name:VAUGHAN, JANE A (FNP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:A
Other - Last Name:MARTIN-VAUGHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1125 MADISON ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-5227
Practice Address - Country:US
Practice Address - Phone:573-632-5357
Practice Address - Fax:573-632-5876
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO096340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1699750091OtherNPI