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Individual

GENIE B VAUGHAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN, CFNP

Contact information

Practice address
1065 E BROAD ST, MONTICELLO, MS 39654-7703
(601) 587-4051
(601) 587-1256
Mailing address
179 TOM SISTRUNK RD, JAYESS, MS 39641-3781
(601) 587-2678

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R776769
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00124884
MS
Enumeration date
08/31/2006
Last updated
07/08/2007
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