Healthcare Provider Details

I. General information

NPI: 1619374022
Provider Name (Legal Business Name): BRIAN YANCY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 CAPURRO WAY SUITE 100
SPARKS NV
89431-8518
US

IV. Provider business mailing address

6718 PANTHER CREEK DR
SPARKS NV
89436-9410
US

V. Phone/Fax

Practice location:
  • Phone: 775-420-5396
  • Fax:
Mailing address:
  • Phone: 775-412-2443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: