Healthcare Provider Details

I. General information

NPI: 1871328104
Provider Name (Legal Business Name): BREANNA LEIGH YAGGY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 BRANSON LANDING BLVD STE 306
BRANSON MO
65616-2140
US

IV. Provider business mailing address

525 BRANSON LANDING BLVD STE 306
BRANSON MO
65616-2140
US

V. Phone/Fax

Practice location:
  • Phone: 417-335-3558
  • Fax:
Mailing address:
  • Phone: 417-335-7558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2024036238
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: