Healthcare Provider Details

I. General information

NPI: 1134947641
Provider Name (Legal Business Name): GINA YEAGER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 STARBRUSH CIR
COVINGTON LA
70433-7208
US

IV. Provider business mailing address

56 STARBRUSH CIR
COVINGTON LA
70433-7208
US

V. Phone/Fax

Practice location:
  • Phone: 985-246-5670
  • Fax: 985-246-5667
Mailing address:
  • Phone: 985-246-5670
  • Fax: 985-246-5667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number280716
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: