Individual provider Active NPI

Priscilla S Vaughn, FNP

  • Family Nurse Practitioner
  • Fontana, CA
National Provider Identifier
1679373963
Registry record updated Jun 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95035253 Issued in CA
Practice address
14685 Decoy LN
Fontana, CA 92336-0414
Phone
(909) 561-8085
NPI assigned
Mar 15, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95035253 CA Primary

Addresses

Primary practice location

14685 Decoy LN
Fontana, CA 92336-0414

Mailing address

14685 Decoy LN
Fontana, CA 92336-0414
Phone (909) 561-8085

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20251120004252 CA Practitioner - Nurse Practitioner 9436641008 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ignite Emergency Physicians a Medical CorporationGroup PAC ID 2365988326, 46 clinicians

Practice addresses (Care Compare)

5000 San Bernardino St
Montclair, CA 91763-2326
Phone (909) 625-5411

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95035253CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ignite Emergency Physicians a Medical Corporation CurrentSince Sep 8, 2025 Accepting new patients

Locations

5451 Walnut Ave
Chino, CA 91710
Phone (909) 464-8600

5000 San Bernardino St
Montclair, CA 91763
Phone (909) 625-4111

1801 W Olympic Blvd
#2611
Pasadena, CA 91199

16850 Bear Valley Rd
Victorville, CA 92395
Phone (760) 241-8222

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1741996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748908800000",
    "number": "1679373963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14685 DECOY LN",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923360414",
            "telephone_number": "909-561-8085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14685 DECOY LN",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923360414",
            "telephone_number": "909-561-8085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHN",
        "first_name": "PRISCILLA",
        "middle_name": "S",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-15",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95035253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

Verify at the official NPI Registry.