Healthcare Provider Details

I. General information

NPI: 1700420338
Provider Name (Legal Business Name): REBECCA JOANNE YAUILLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 HARRISON ST STE D
BATESVILLE AR
72501-7444
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 870-569-4290
  • Fax: 870-569-4293
Mailing address:
  • Phone: 870-347-2534
  • Fax: 501-748-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number122505
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: