Healthcare Provider Details

I. General information

NPI: 1174970958
Provider Name (Legal Business Name): KATHRYN CAMERON YEAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN CAMERON SKOGLUND

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2575
US

IV. Provider business mailing address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2575
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-4357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2023-00712
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: