Individual
BRENILLA VAUGHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
747 INDUSTRIAL PARK RD NE, BROOKHAVEN, MS 39601-2065
(601) 833-4111
Mailing address
747 INDUSTRIAL PARK RD NE, BROOKHAVEN, MS 39601-2065
(601) 833-4111
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
902851
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002187356
—
MS
Enumeration date
02/04/2019
Last updated
01/10/2023
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