MEDICARE: FARRAH VAUGHN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024174094	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0024174094	OTHER	VA	LICENSED NURSE PRACTITIONER
2	0017143338	OTHER	VA	AUTHORIZATION TO PRESCRIBE

General Provider Information

NPI Number	:	1881146694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARRAH VAUGHN FNP

Provider Business Mailing Address
First Line	:	1021 W OAKLAND AVE STE 310
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2192
Country	:	US
Telephone Number	:	423-952-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 W RIDGE RD STE D
Second Line	:
City	:	WYTHEVILLE
State	:	VA
Zip	:	24382-1067
Country	:	US
Telephone Number	:	276-228-5506
Fax Number	:	276-228-2040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	03/25/2025

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