Healthcare Provider Details

I. General information

NPI: 1386343085
Provider Name (Legal Business Name): CHRISTA ANN YEAKLE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 S MAIN ST STE 100
UPLAND IN
46989-9258
US

IV. Provider business mailing address

1809 S MAIN ST STE 100
UPLAND IN
46989-9258
US

V. Phone/Fax

Practice location:
  • Phone: 765-770-0650
  • Fax: 765-770-0652
Mailing address:
  • Phone: 765-770-0650
  • Fax: 765-770-0652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71013623A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: