Healthcare Provider Details

I. General information

NPI: 1669812681
Provider Name (Legal Business Name): KIMBERLY ANN YEAGER APRN,BC,FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 S DIVISION ST STE A
BONNE TERRE MO
63628-1701
US

IV. Provider business mailing address

11 S DIVISION ST STE A
BONNE TERRE MO
63628-1701
US

V. Phone/Fax

Practice location:
  • Phone: 573-723-1100
  • Fax: 573-723-1130
Mailing address:
  • Phone: 573-723-1100
  • Fax: 573-723-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013018585
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: