1760441000 NPI number — CHERYL LYNN YELVERTON MD

Table of content: PARAVEE PRAKONGSUP (NPI 1659837441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760441000 NPI number — CHERYL LYNN YELVERTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YELVERTON
Provider First Name:
CHERYL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1760441000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 NW 82ND AVE
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33324-7808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-835-2788
Provider Business Mailing Address Fax Number:
954-430-4362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 NW 82ND AVE
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33324-7808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-835-2788
Provider Business Practice Location Address Fax Number:
954-430-4362
Provider Enumeration Date:
03/23/2006

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:  ME88999 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X , with the licence number: ME88999 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4000077731000 . This is a "PREFERRED CARE PARTNERS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 273005700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14004 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: SG078267 . This is a "VISTA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00002555557 07 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 20521 . This is a "EVOLUTIONS HEALTHCARE SYSTEMS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5662247 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 301594 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9505291 . This is a "MULTIPLAN/PCHS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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