Active NPI
Kendra Renee Vaughn, MS CCC/SLP
- Speech-Language Pathologist
- Fort Worth, TX
National Provider Identifier
1689964629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 18129
- Practice address
- 12457 Timberland Blvd
Suite 205
Fort Worth, TX 76244-5210 - Phone
- (817) 602-9298
- NPI assigned
- Apr 11, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 18129 | TX | Primary |
Addresses
Primary practice location
12457 Timberland Blvd
Suite 205
Fort Worth, TX 76244-5210
Mailing address
12457 Timberland Blvd
Suite 205
Fort Worth, TX 76244-5210
Phone (817) 602-9298
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18129 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340064000000",
"number": "1689964629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12457 TIMBERLAND BLVD",
"address_2": "SUITE 205",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "762445210",
"telephone_number": "817-602-9298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12457 TIMBERLAND BLVD",
"address_2": "SUITE 205",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "762445210",
"telephone_number": "817-602-9298"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAUGHN",
"first_name": "KENDRA",
"middle_name": "RENEE",
"credential": "MS CCC/SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-04-11",
"last_updated": "2012-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "18129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.