Provider Demographics
NPI:1942338082
Name:VAUGHN, JOANN WOLFE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:WOLFE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3644
Practice Address - Street 1:103 NORTH STREET
Practice Address - Street 2:RIDGEVIEW PAVILION
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201
Practice Address - Country:US
Practice Address - Phone:423-844-6000
Practice Address - Fax:423-844-6002
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARN0001040254363L00000X
TNAPN5087363L00000X
VA0024040254LNP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I503112Medicare PIN
VACO307458Medicare PIN