Healthcare Provider Details

I. General information

NPI: 1255797221
Provider Name (Legal Business Name): MICHELLE KRISTEN YEAGER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PHILADELPHIA DR
DAYTON OH
45406-1840
US

IV. Provider business mailing address

2200 PHILADELPHIA DR
DAYTON OH
45406-1840
US

V. Phone/Fax

Practice location:
  • Phone: 937-734-1600
  • Fax:
Mailing address:
  • Phone: 937-734-1432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN. 326790
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0116522
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: