Individual
KYLE VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
814 KEMPSVILLE RD STE 102, NORFOLK, VA 23502-4001
(757) 623-0005
(757) 389-5412
Mailing address
4445 CORPORATION LN STE 100, VIRGINIA BEACH, VA 23462-3666
(757) 623-0005
(757) 548-1128
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
0010-07079
NC
363AM0700X
Medical Physician Assistant
Primary
0110007161
VA
Other
Enumeration date
02/20/2017
Last updated
01/20/2022
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