Healthcare Provider Details

I. General information

NPI: 1073965083
Provider Name (Legal Business Name): CALEB YEARGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W BARAGA AVE
MARQUETTE MI
49855-4550
US

IV. Provider business mailing address

975 E 3RD ST
CHATTANOOGA TN
37403-2147
US

V. Phone/Fax

Practice location:
  • Phone: 906-449-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704366480
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21363
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number21363
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: