=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942338082
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOANN WOLFE VAUGHN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 06/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 NORTH STREET RIDGEVIEW PAVILION
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-844-6000
-----------------------------------------------------
Fax | 423-844-6002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9054
-----------------------------------------------------
City | GRAY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37615-9054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-467-3600
-----------------------------------------------------
Fax | 423-467-3644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | RN0001040254
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APN5087
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 0024040254LNP
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------