MEDICARE: MS. JOANNE TIMPSON YARRISH FNP/CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN-083151	AZ
2	176B00000X	Midwife	AP6829	AZ

General Provider Information

NPI Number	:	1003897166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOANNE TIMPSON YARRISH FNP/CNM

Provider Business Mailing Address
First Line	:	1675 SOUTH BERRY KNOLL BLVD.
Second Line	:	PO BOX 1549
City	:	COLORADO CITY
State	:	AZ
Zip	:	86021-1549
Country	:	US
Telephone Number	:	928-875-8750
Fax Number	:	928-875-8752

Provider Business Practice Location Address
First Line	:	1675 SOUTH BERRY KNOLL BLVD.
Second Line	:	STE. A
City	:	COLORADO CITY
State	:	AZ
Zip	:	86022-1549
Country	:	US
Telephone Number	:	928-875-8750
Fax Number	:	928-875-8752

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	04/29/2016

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