Provider Demographics
NPI:1073693206
Name:VAUGHN, SANDRA (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:GASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1928 ALCOA HWY STE 209
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1504
Mailing Address - Country:US
Mailing Address - Phone:865-524-2547
Mailing Address - Fax:865-219-5070
Practice Address - Street 1:1928 ALCOA HWY STE 209
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1504
Practice Address - Country:US
Practice Address - Phone:865-524-2547
Practice Address - Fax:865-524-0224
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN12432207N00000X, 363L00000X
GARN083514363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513689Medicaid
TN3341147Medicare PIN