Healthcare Provider Details

I. General information

NPI: 1932978301
Provider Name (Legal Business Name): KIARA RAQUEL YAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 EARNIE LN
HOLLY SPRINGS NC
27540-9186
US

IV. Provider business mailing address

333 EARNIE LN
HOLLY SPRINGS NC
27540-9186
US

V. Phone/Fax

Practice location:
  • Phone: 984-777-8787
  • Fax:
Mailing address:
  • Phone: 984-777-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13625
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: