Healthcare Provider Details

I. General information

NPI: 1912595547
Provider Name (Legal Business Name): JESSICA RENE YELEY MSN,APRN,FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 05/17/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 KANELL BLVD
POPLAR BLUFF MO
63901-4011
US

IV. Provider business mailing address

2060 HIGHWAY HH
POPLAR BLUFF MO
63901-5368
US

V. Phone/Fax

Practice location:
  • Phone: 573-727-9130
  • Fax: 573-727-9128
Mailing address:
  • Phone: 573-727-9130
  • Fax: 573-727-9128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2016003492
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021001528
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: