Healthcare Provider Details

I. General information

NPI: 1538092994
Provider Name (Legal Business Name): KISTNER YVONNE JAVORSKI R.R.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

101 SHADOW RIDGE PL
CHAPEL HILL NC
27516-4316
US

V. Phone/Fax

Practice location:
  • Phone: 609-335-5886
  • Fax:
Mailing address:
  • Phone: 609-335-5886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number547923
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number547923
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: