Individual
DIANE B VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GNP
Contact information
Practice address
1340 BROAD AVE, SUITE 450, GULFPORT, MS 39501-2404
(228) 865-3202
(228) 865-3249
Mailing address
PO BOX 555, BILOXI, MS 39533-0555
(228) 865-3202
(228) 865-3249
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
R621641
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01128596
—
MS
Enumeration date
07/24/2007
Last updated
08/24/2010
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