Healthcare Provider Details

I. General information

NPI: 1962481515
Provider Name (Legal Business Name): CLARIZEL CONCEPCION YARBROUGH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PARK ST
BOWLING GREEN KY
42101-1760
US

IV. Provider business mailing address

350 PARK ST STE 203 B
BOWLING GREEN KY
42101-1784
US

V. Phone/Fax

Practice location:
  • Phone: 270-745-1000
  • Fax: 270-393-1913
Mailing address:
  • Phone: 270-393-1912
  • Fax: 270-393-1913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number73922
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: