Dominique Nicole Vaughn, AGNP-C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

35863 Issued in TN

Practice address

682 Woodland Fox LN W
Cordova, TN 38018-1147

Phone

(901) 436-0542

NPI assigned

Feb 21, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Theoria MedicalGroup PAC ID 5395098339, 317 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375

  Nurse Practitioner, TN

  Medicare reassignment Care Compare group NPD
• Complexcare Medical Group Mid-Atlantic H PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1275427429

  TN

  Medicare reassignment NPD
• Total Extended Care Services PC

  • Physical Medicine & Rehabilitation Physician
  • Englewood, OH
  • NPI 1699522029

  TN

  Medicare reassignment NPD
• Oak Street Health Physicians Group of Tennessee, PLLC

  • Internal Medicine Physician
  • Memphis, TN
  • NPI 1760116172
  NPD
• Complexcare Medical Group Midwest M PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1528851607

  Nurse Practitioner

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747008000000",
    "number": "1124884895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "682 WOODLAND FOX LN W",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380181147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "682 WOODLAND FOX LN W",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380181147",
            "telephone_number": "901-436-0542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHN",
        "first_name": "DOMINIQUE",
        "middle_name": "NICOLE",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-21",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TN",
            "license": "35863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandeep Vasishta, OTR
• Sarah Elisabeth Vasquez
• Renga I Vasu, M.D.
• Donnie A Vaughan, HIS
• Thomas W. Vaughan, HIS
• Lindsey Beth Vaughn, FNP-C
• Grace Deles Vedala, PHYSICAL THERAPIST
• Raghunath Vedala, MSCCCSLP
• Ashlei Nicole Vester
• Veterans Choice Mental Health Services LLC

• Gerontology Nurse Practitioner in Cordova, TN
• Providers in Cordova, TN by specialty
• Gerontology Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.