Healthcare Provider Details

I. General information

NPI: 1114016185
Provider Name (Legal Business Name): KRISTINE MARIE YEARWOOD DNP-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINE MARIE VARGA DNP-FNP

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD TRIPLER ARMY MEDICAL CENTER
HONOLULU HI
96859
US

IV. Provider business mailing address

1601 HARMON AVE
FORT STEWART GA
31314-5641
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-2155
  • Fax:
Mailing address:
  • Phone: 912-435-6965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number735063
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1611
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number07731
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: