Healthcare Provider Details

I. General information

NPI: 1326786906
Provider Name (Legal Business Name): YAVAPAI FAMILY MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 E FLORENTINE RD STE A
PRESCOTT VALLEY AZ
86314-2245
US

IV. Provider business mailing address

7750 E FLORENTINE RD STE A
PRESCOTT VALLEY AZ
86314-2245
US

V. Phone/Fax

Practice location:
  • Phone: 928-277-1211
  • Fax: 928-277-1239
Mailing address:
  • Phone: 928-277-1211
  • Fax: 928-277-1239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LOUELLA BAUMAN
Title or Position: OWNER
Credential: NP
Phone: 928-277-1211