1649537853 NPI number — DR. PHYLICIA DANIELLE YORGURE M.D.

Table of content: (NPI 1881681922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649537853 NPI number — DR. PHYLICIA DANIELLE YORGURE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YORGURE
Provider First Name:
PHYLICIA
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUPREE
Provider Other First Name:
PHYLICIA
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649537853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 719
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNNYSIDE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98944-0719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-837-1617
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 VINTAGE VALLEY PKWY STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZILLAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98953-9800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-314-6565
Provider Business Practice Location Address Fax Number:
509-314-6564
Provider Enumeration Date:
04/12/2012

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: 208600000X , with the licence number:  S7041 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: MD61555498 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com