Healthcare Provider Details

I. General information

NPI: 1245931146
Provider Name (Legal Business Name): DAVID ANDREW YOSICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SIJEN AVE
WHITEMAN AFB MO
65305-1269
US

IV. Provider business mailing address

4881 SUGAR MAPLE DR
DAYTON OH
45433-5529
US

V. Phone/Fax

Practice location:
  • Phone: 660-687-7931
  • Fax:
Mailing address:
  • Phone: 937-257-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: