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Individual

JESSICA N VAUGHN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1707 S COLORADO ST STE A, GREENVILLE, MS 38703-7275
(662) 335-8332
(662) 335-8852
Mailing address
1707 S COLORADO ST STE A, GREENVILLE, MS 38703-7275
(662) 335-8332
(662) 335-8852

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA4876
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
09015486
MS
01
256579
MEDICARE
MS
01
640925683
BLUE CROSS BLUE SHIELD
MS
Enumeration date
05/16/2012
Last updated
05/16/2012
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