Healthcare Provider Details

I. General information

NPI: 1528514528
Provider Name (Legal Business Name): STACY YANCEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 FERNDALE BLVD
HIGH POINT NC
27262-4739
US

IV. Provider business mailing address

3979 NAVY PL
HIGH POINT NC
27265-9443
US

V. Phone/Fax

Practice location:
  • Phone: 336-882-2567
  • Fax:
Mailing address:
  • Phone: 336-870-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number113039
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number245610
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: