Healthcare Provider Details

I. General information

NPI: 1922630367
Provider Name (Legal Business Name): JAMES BRAXTON YEAGER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCY WAY
BELLA VISTA AR
72714-3000
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 479-802-5555
  • Fax: 479-876-2829
Mailing address:
  • Phone: 479-802-5555
  • Fax: 479-876-2829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF01201834
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: