Healthcare Provider Details

I. General information

NPI: 1003897166
Provider Name (Legal Business Name): JOANNE TIMPSON YARRISH FNP/CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 SOUTH BERRY KNOLL BLVD. STE. A
COLORADO CITY AZ
86022-1549
US

IV. Provider business mailing address

1675 SOUTH BERRY KNOLL BLVD. PO BOX 1549
COLORADO CITY AZ
86021-1549
US

V. Phone/Fax

Practice location:
  • Phone: 928-875-8750
  • Fax: 928-875-8752
Mailing address:
  • Phone: 928-875-8750
  • Fax: 928-875-8752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN-083151
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAP6829
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: