Healthcare Provider Details

I. General information

NPI: 1932875283
Provider Name (Legal Business Name): JESSICA RENEE YEARBY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA RENEE KALAF RN

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1656 CHAMPLIN AVE
UTICA NY
13502-4830
US

IV. Provider business mailing address

2209 GENESEE ST. BUSINESS OFFICE
UTICA NY
13501-5930
US

V. Phone/Fax

Practice location:
  • Phone: 131-540-4848
  • Fax:
Mailing address:
  • Phone: 315-801-4238
  • Fax: 315-801-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF348013-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: