Healthcare Provider Details

I. General information

NPI: 1992213318
Provider Name (Legal Business Name): JESSICA LYNN YEBERNETSKY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HOSPITAL AVE
DU BOIS PA
15801-1409
US

IV. Provider business mailing address

123 HOSPITAL AVE
DU BOIS PA
15801-1409
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-2922
  • Fax:
Mailing address:
  • Phone: 814-371-2922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP017845
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP017845
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: