Provider Demographics
NPI:1871966796
Name:VAUGHAN, CHRISTINE ANN (FNP)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ANN
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 505500
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5500
Mailing Address - Country:US
Mailing Address - Phone:636-349-5437
Mailing Address - Fax:636-349-6663
Practice Address - Street 1:714 GRAVOIS RD
Practice Address - Street 2:STE 200
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7766
Practice Address - Country:US
Practice Address - Phone:636-349-5437
Practice Address - Fax:636-349-6663
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2020029683363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420090531Medicaid