# EMPOWERED PEDIATRICS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689371049
- **Authorized official:** JERRICA VAUGHAN CPNP (PEDIATRIC NURSE PRACTITIONER)
- **Authorized official phone:** (262) 307-1319

## Contact information

- **Practice address:** W229N1433 WESTWOOD DR STE 104, WAUKESHA, WI 53186-1172
- **Practice address phone:** (262) 307-1319
- **Practice address fax:** (855) 857-9099
- **Mailing address:** W229N1433 WESTWOOD DR STE 104, WAUKESHA, WI 53186-1172
- **Mailing address phone:** (262) 307-1319
- **Mailing address fax:** (855) 857-9099

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 02/15/2023
- **Last updated:** 02/15/2023