Healthcare Provider Details

I. General information

NPI: 1083298285
Provider Name (Legal Business Name): DOUGLAS YEAGER QBHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E CRANDALL AVE STE B
HARRISON AR
72601-3628
US

IV. Provider business mailing address

2885 W BATTLEFIELD ST
SPRINGFIELD MO
65807-3952
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-8484
  • Fax: 870-741-4088
Mailing address:
  • Phone: 417-761-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number0000
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: