Provider Demographics
NPI:1073606539
Name:VAUGHAN, TANNA S (ARNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:TANNA
Middle Name:S
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 MEDICAL CENTER CIR
Mailing Address - Street 2:STE 308
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-1193
Mailing Address - Country:US
Mailing Address - Phone:270-251-4495
Mailing Address - Fax:270-251-4496
Practice Address - Street 1:330 SEVEN SPRINGS WAY
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5098
Practice Address - Country:US
Practice Address - Phone:615-920-7905
Practice Address - Fax:615-920-8775
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3727P363L00000X
KY3003727363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000371343OtherKY ANTHEM BCBS
KYP00265239OtherRAILROAD MEDICARE
KYP00265239OtherRAILROAD MEDICARE
KY000000371343OtherKY ANTHEM BCBS