Healthcare Provider Details

I. General information

NPI: 1609599083
Provider Name (Legal Business Name): YOLANDA LIVINGSTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DR
FORT CAMPBELL KY
42223-8355
US

IV. Provider business mailing address

2143 HIGHWAY 41 S
GREENBRIER TN
37073-4534
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-4677
  • Fax:
Mailing address:
  • Phone: 615-205-1277
  • Fax: 615-205-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number31889
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0000031889
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: