1386343085 NPI number — CHRISTA ANN YEAKLE FNP-C

Table of content: CHRISTA ANN YEAKLE FNP-C (NPI 1386343085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386343085 NPI number — CHRISTA ANN YEAKLE FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YEAKLE
Provider First Name:
CHRISTA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
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:
1386343085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1809 S MAIN ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46989-9258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-770-0650
Provider Business Mailing Address Fax Number:
765-770-0652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1809 S MAIN ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46989-9258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-770-0650
Provider Business Practice Location Address Fax Number:
765-770-0652
Provider Enumeration Date:
03/01/2023

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: 363LF0000X , with the licence number:  71013623A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 71013623B . This is a "CSR- PRESCRIPTIVE AUTHORITY" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 71013623A . This is a "STATE OF INDIANA APRN PRESCRIPTIVE AUTHORITY" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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