Individual
MS. IVA NELL VAUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
22A DOCTORS DR, OCEAN SPRINGS, MS 39564-5721
(228) 872-1951
(228) 875-9998
Mailing address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R753601
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05078304
—
MS
01
—
09014182
MEDICAID GROUP #
MS
01
—
500028696
RAILROAD MEDICARE
—
01
—
646000515
BLUE CROSS OF MS
—
01
—
C00047
MEDICARE GROUP #
MS
Enumeration date
05/17/2007
Last updated
06/27/2013
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