Provider Demographics
NPI:1760255681
Name:WAUGH, MCKINLEY JACKSON (DNP, CPNP-PC)
Entity Type:Individual
Prefix:DR
First Name:MCKINLEY
Middle Name:JACKSON
Last Name:WAUGH
Suffix:
Gender:F
Credentials:DNP, CPNP-PC
Other - Prefix:MS
Other - First Name:MCKINLEY
Other - Middle Name:SUZANNE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1286 NEYLAND CIR
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-6901
Mailing Address - Country:US
Mailing Address - Phone:706-691-5547
Mailing Address - Fax:
Practice Address - Street 1:900 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2101
Practice Address - Country:US
Practice Address - Phone:423-778-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN233323163WP0200X
TN34655363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics