Individual
KELLY MEAD GAUGHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036.137326
IL
208000000X
Pediatrics Physician
Primary
20A22401
CA
208000000X
Pediatrics Physician
34.012728
OH
390200000X
Student in an Organized Health Care Education/Training Program
AC3890313-T050
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
270950
—
OH
Enumeration date
06/25/2012
Last updated
10/03/2024
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