Healthcare Provider Details

I. General information

NPI: 1417421579
Provider Name (Legal Business Name): STEPHANIE MARIE YEAGER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE M DOWLER FNP

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 S NATIONAL AVE STE 700
SPRINGFIELD MO
65807-5292
US

IV. Provider business mailing address

PO BOX 9007
SPRINGFIELD MO
65808-9007
US

V. Phone/Fax

Practice location:
  • Phone: 417-875-3065
  • Fax: 417-875-3589
Mailing address:
  • Phone: 417-875-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2018038759
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2018038759
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: