Healthcare Provider Details

I. General information

NPI: 1760812234
Provider Name (Legal Business Name): KELLY AMANDA YANCER BS HAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY AMANDA WYCOFF BS, HAD

II. Dates (important events)

Enumeration Date: 11/20/2013
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 MERCHANT MILE
COLUMBUS IN
47201-1573
US

IV. Provider business mailing address

1700 N UNIVERSITY DR
PLANTATION FL
33322-4107
US

V. Phone/Fax

Practice location:
  • Phone: 812-372-1557
  • Fax:
Mailing address:
  • Phone: 877-439-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001391A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: