Clark K Vaughan, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

01221 Issued in WV

Practice address

109 College Ave
Beckley, WV 25801-6018

Phone

(304) 545-2152

Fax

(304) 255-7120

NPI assigned

Sep 2, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cvaughan223603@direct.med.utah.edu

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• University of Utah

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1588656870
  Medicare reassignment NPD
• University of Utah

  • General Acute Care Hospital
  • Salt Lake City, UT
  • NPI 1699889576
  NPD
• University of Utah Community Physicians Group

  • Family Medicine Physician
  • Park City, UT
  • NPI 1053715763
  NPD
• Praxis Corporation

  • Physical Therapy Clinic/Center
  • Pineville, WV
  • NPI 1669594719
  NPD (past)
• Altitude Physical Therapy & Sports Medicine LLC

  • Physical Therapy Clinic/Center
  • Longmont, CO
  • NPI 1235729567
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1659365898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 COLLEGE AVE",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258016018",
            "telephone_number": "304-545-2152",
            "fax_number": "304-255-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 COLLEGE AVE",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258016018",
            "telephone_number": "304-545-2152",
            "fax_number": "304-255-7120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHAN",
        "first_name": "CLARK",
        "middle_name": "K",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-02",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WV",
            "license": "01221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "157476000",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cvaughan223603@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Patience Naomi Vandyke
• Amanda Vanhoose, PHARM D.
• Dennis Carl Vanmeter
• Justin Vanover
• William Jack Varney Jr., PHARMACIST
• Paul Michael Vaughan, PT
• John David Vaughn
• Kellie Beth Vaught, MSN, APRN, BC
• Vein Care of the Virginias PLLC
• Velayudhan Sahadevan M D PH D

• Physical Therapist in Beckley, WV
• Providers in Beckley, WV by specialty
• Physical Therapist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.