Wallisa Tejarnette Vaughn, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0101255299 Issued in VA

Practice address

850 Kempsville Rd Ste 200a
Norfolk, VA 23502-3920

Phone

(757) 261-5910

NPI assigned

Sep 10, 2007

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA, WV2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Blue Ridge Behavioral Healthcare

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Roanoke, VA
  • NPI 1437137734
  Medicare reassignment NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • Health Maintenance Organization
  • Lansdowne, VA
  • NPI 1861552721

  Family Medicine

  Medicare reassignment NPD
• Universal Health Corporation

  • Internal Medicine Physician
  • Roanoke, VA
  • NPI 1407117625
  Medicare reassignment NPD
• University Healthcare Physicians, Inc.

  • Family Medicine Physician
  • Martinsburg, WV
  • NPI 1659625739
  Medicare reassignment NPD
• Jencare Neighborhood Medical New Market, LLC

  • Internal Medicine Physician
  • Newport News, VA
  • NPI 1568756948
  NPD
• Kaiser Foundation Health Plan of the Mid Atlantic States, Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockville, MD
  • NPI 1962108753
  NPD
• PMR Virginia Holding, LLC

  • Specialist
  • Miami Gardens, FL
  • NPI 1083167001
  NPD
• University Healthcare Physicians Inc

  • Anesthesiology Physician
  • Martinsburg, WV
  • NPI 1417371329
  NPD
• Diamond Hill SNF Operations LLC

  • Skilled Nursing Facility
  • Lynchburg, VA
  • NPI 1679247563
  NPD (past)

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

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737676800000",
    "number": "1992990238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5060 VALLEY VIEW BLVD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240122038",
            "telephone_number": "540-278-1051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 KEMPSVILLE RD STE 200A",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235023920",
            "telephone_number": "757-261-5910"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5060 Valley View Blvd NW",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240122038",
            "country_code": "US",
            "telephone_number": "540-278-1051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAUGHN",
        "first_name": "WALLISA",
        "middle_name": "TEJARNETTE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-10",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101255299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5060 Valley View Blvd NW",
            "city": "Roanoke",
            "state": "VA",
            "country_code": "US",
            "postal_code": "240122038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kimberly Vaughan
• Tierra Marie Vaughan
• Krystal Vaughn
• Kyle Vaughn, PA-C
• Shekinah Joy Vaughn, MD
• Ana H. Vazquez, M.D.
• VCDS
• VCDS Virginia Consumer Directed Services
• Dani Vedros
• Manik Veer, MD

• Family Medicine Physician in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.