Individual
MR. JONATHAN W VAUGHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6441
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6441
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R872243
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01757892
—
MS
Enumeration date
08/25/2009
Last updated
12/29/2015
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