Healthcare Provider Details

I. General information

NPI: 1326529470
Provider Name (Legal Business Name): MICAH CALEB YANCE MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/09/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 US-231 STE 9&10
TROY AL
36081
US

IV. Provider business mailing address

113 ABBY LN
TROY AL
36079-4003
US

V. Phone/Fax

Practice location:
  • Phone: 334-465-8000
  • Fax:
Mailing address:
  • Phone: 334-714-9810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2515
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: