Healthcare Provider Details

I. General information

NPI: 1003266933
Provider Name (Legal Business Name): LEAH RAY YEAGER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST CC417
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

800 ROSE ST CC417
LEXINGTON KY
40536-7001
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-1223
  • Fax: 859-323-2749
Mailing address:
  • Phone: 859-257-1223
  • Fax: 859-323-2749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010364
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: