Brenilla Vaughn, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

902851 Issued in MS

Practice address

747 Industrial Park Rd NE
Brookhaven, MS 39601-2065

Phone

(601) 833-4111

NPI assigned

Feb 4, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Minor Med Care, LLCGroup PAC ID 7618866021, 77 clinicians

MDB Behavioral Health Services LLCGroup PAC ID 0749572915, 201 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• King'S Daughters Medical Center-Brookhaven Hospital, Brookhaven, MS, CCN 250057
• Southwest Ms Regional Medical Center Hospital, McComb, MS, CCN 250097

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: brenilla.vaughn.1@23402.direct.athenahealth.com

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.

• MDB Behavioral Health Services LLC

  • Rural Health Clinic/Center
  • Vicksburg, MS
  • NPI 1669835310

  MS, Single Specialty

  Medicare reassignment Care Compare group NPD
• Minor Med Care, LLC

  • Primary Care Clinic/Center
  • Jackson, MS
  • NPI 1407968738

  MS, Single Specialty

  Medicare reassignment Care Compare group NPD
• MDB Care Management LLC

  • Primary Care Nurse Practitioner
  • Flowood, MS
  • NPI 1144925272

  MS, Single Specialty

  Medicare reassignment NPD
• Uppal Medical Center LLC

  • Rural Health Clinic/Center
  • Greenville, MS
  • NPI 1558927905

  MS, Single Specialty

  Medicare reassignment NPD
• Grayer Professional Nursing Services

  • Nurse Practitioner
  • Union Church, MS
  • NPI 1386517613

  Single Specialty

  NPD Authorized official
• Minor Med Care, LLC

  • Rural Health Clinic/Center
  • Raymond, MS
  • NPI 1669575627
  Care Compare group NPD
• Anointed Nephrology & HTN PLLC

  • Specialist
  • Brookhaven, MS
  • NPI 1447563499

  MS

  Medicare reassignment

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• King'S Daughters Medical Center

  • General Acute Care Hospital
  • Brookhaven, MS
  • NPI 1972503464

  Hospital

  Care Compare affiliation
• Southwest Mississippi Regional Medical Center

  • General Acute Care Hospital
  • McComb, MS
  • NPI 1407805971

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1549238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673308800000",
    "number": "1669937611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "747 INDUSTRIAL PARK RD NE",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012065",
            "telephone_number": "601-833-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "747 INDUSTRIAL PARK RD NE",
            "city": "BROOKHAVEN",
            "state": "MS",
            "postal_code": "396012065",
            "telephone_number": "601-833-4111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "557 Grant Ferry Rd",
            "address_purpose": "LOCATION",
            "city": "Brandon",
            "state": "MS",
            "postal_code": "390479023",
            "country_code": "US",
            "telephone_number": "601-665-4162",
            "fax_number": "855-830-3484",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAUGHN",
        "first_name": "BRENILLA",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-04",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "902851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002187356",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kersten Vanem, MS PMHT
• Mendez G Vaughn, OT
• W. Don Doty, D.M.D., General Dentistry, a Professional Corp
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co

• All providers in Brookhaven, MS
• Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.