Healthcare Provider Details

I. General information

NPI: 1609334879
Provider Name (Legal Business Name): TREVOR LAURENCE YAKLE NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 NALL AVE STE 200
OVERLAND PARK KS
66211-1358
US

IV. Provider business mailing address

9207 SLATER ST
OVERLAND PARK KS
66212-3826
US

V. Phone/Fax

Practice location:
  • Phone: 913-381-5225
  • Fax: 913-901-0186
Mailing address:
  • Phone: 620-228-8009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019006490
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-78626-122
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: