Healthcare Provider Details

I. General information

NPI: 1730647918
Provider Name (Legal Business Name): JOSIAH M MATTHEW YANCE FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E SOUTH BLVD
MONTGOMERY AL
36116-2409
US

IV. Provider business mailing address

1005 AUBURN ST
OPELIKA AL
36801-5701
US

V. Phone/Fax

Practice location:
  • Phone: 334-796-3702
  • Fax:
Mailing address:
  • Phone: 334-796-3702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-146919
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-146919
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: