Healthcare Provider Details

I. General information

NPI: 1831842152
Provider Name (Legal Business Name): KENNY RAY YANCEY APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 S HIGHWAY 27
STEARNS KY
42647-6297
US

IV. Provider business mailing address

PO BOX 68
STEARNS KY
42647-0068
US

V. Phone/Fax

Practice location:
  • Phone: 606-376-9700
  • Fax: 606-376-9703
Mailing address:
  • Phone: 606-376-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3017108
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3017108
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: