Provider Demographics
NPI:1881146694
Name:VAUGHN, FARRAH (FNP)
Entity type:Individual
Prefix:
First Name:FARRAH
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-952-2111
Mailing Address - Fax:
Practice Address - Street 1:590 W RIDGE RD STE D
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1067
Practice Address - Country:US
Practice Address - Phone:276-228-5506
Practice Address - Fax:276-228-2040
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174094363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024174094OtherLICENSED NURSE PRACTITIONER
VA0017143338OtherAUTHORIZATION TO PRESCRIBE