Healthcare Provider Details

I. General information

NPI: 1144923897
Provider Name (Legal Business Name): LAUREN NICOLE VAHLKAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N STATE OF FRANKLIN RD
JOHNSON CITY TN
37604-6035
US

IV. Provider business mailing address

102 STONEWALL JACKSON DR UNIT 3
ELIZABETHTON TN
37643-2987
US

V. Phone/Fax

Practice location:
  • Phone: 423-431-6111
  • Fax:
Mailing address:
  • Phone: 217-440-0618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110010685
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110010685
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5551
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5551
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: