Healthcare Provider Details

I. General information

NPI: 1114996378
Provider Name (Legal Business Name): STEPHANIE W VAUGHN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 GALLATIN RD N
MADISON TN
37115-2104
US

IV. Provider business mailing address

1616 GALLATIN RD N
MADISON TN
37115-2104
US

V. Phone/Fax

Practice location:
  • Phone: 615-865-8500
  • Fax: 615-860-8061
Mailing address:
  • Phone: 615-865-8500
  • Fax: 615-860-8061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN7025
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: