1104775089 NPI number — MRS. TIFFANY CHESTER YERGER PT, MPT

Table of content: MRS. TIFFANY CHESTER YERGER PT, MPT (NPI 1104775089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104775089 NPI number — MRS. TIFFANY CHESTER YERGER PT, MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YERGER
Provider First Name:
TIFFANY
Provider Middle Name:
CHESTER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT, MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104775089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2915 HIGHWAY 602
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TALLULAH
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71282-5858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-281-8192
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 HIGHWAY 61 N STE 1200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VICKSBURG
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39183-8246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-883-3506
Provider Business Practice Location Address Fax Number:
601-883-3501
Provider Enumeration Date:
01/24/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  6336 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 04419 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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