1639453806 NPI number — MRS. RACHAEL JULIET YARBROUGH CNM

Table of content: MRS. RACHAEL JULIET YARBROUGH CNM (NPI 1639453806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639453806 NPI number — MRS. RACHAEL JULIET YARBROUGH CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YARBROUGH
Provider First Name:
RACHAEL
Provider Middle Name:
JULIET
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON /BROOKS
Provider Other First Name:
RACHAEL
Provider Other Middle Name:
JULIET
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNM
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639453806
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 RIO DULCE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79932-2359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-345-1712
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5200 HARRY HINES BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235-7709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-590-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2011

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: 367A00000X , with the licence number:  810243 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1639453806 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".