MEDICARE: NICOLE YEDLINSKY MD

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	207Q00000X	Family Medicine Physician	0101259752	VA
2	207Q00000X	Family Medicine Physician	1056447A	IN
3	207Q00000X	Family Medicine Physician	04-40064	KS

General Provider Information

NPI Number	:	1366431645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE YEDLINSKY MD

Provider Business Mailing Address
First Line	:	3901 RAINBOW BLVD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-8500
Country	:	US
Telephone Number	:	913-588-1944
Fax Number	:	913-588-2496

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	MAILSTOP 4010
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-1710
Country	:	US
Telephone Number	:	913-588-1944
Fax Number	:	913-588-2496

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/21/2022

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