Organization
MERIDIAN THERAPEUTICS CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIMARA VAUGHN NP (OWNER/ NURSE PRACTITIONER)
(602) 606-2658
Entity
Organization
Contact information
Practice address
4045 E BELL RD, STE 111, PHOENIX, AZ 85032-2236
(602) 606-2658
(602) 428-7003
Mailing address
4045 E BELL RD, STE 111, PHOENIX, AZ 85032-2236
(602) 606-2658
(602) 428-7003
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000
UNKNOWN
—
Enumeration date
03/08/2016
Last updated
03/08/2016
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