Healthcare Provider Details

I. General information

NPI: 1336254671
Provider Name (Legal Business Name): KRISTIE L YARMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 RUSSELL STREET
CRAIG CO
81625-2019
US

IV. Provider business mailing address

785 RUSSELL STREET
CRAIG CO
81625-2019
US

V. Phone/Fax

Practice location:
  • Phone: 970-826-2400
  • Fax: 970-826-2429
Mailing address:
  • Phone: 970-826-2400
  • Fax: 970-826-2429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number51212
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier10053755
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerAMERIGROUP
# 2
Identifier000457400
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer
# 3
Identifier336546
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerWELLCARE
# 4
Identifier1336254671
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerMEDICARE
# 5
Identifier19551339
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer
# 6
Identifier230109642A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: