Healthcare Provider Details

I. General information

NPI: 1073911202
Provider Name (Legal Business Name): SUSAN SAYLOR YEARY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S LIMESTONE
LEXINGTON KY
40508-3008
US

IV. Provider business mailing address

1211 RICHMOND RD APT 4
LEXINGTON KY
40502-1607
US

V. Phone/Fax

Practice location:
  • Phone: 859-266-7170
  • Fax:
Mailing address:
  • Phone: 859-312-5179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-10983
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberTC352
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: