Healthcare Provider Details

I. General information

NPI: 1780357889
Provider Name (Legal Business Name): DILLON J YEAGER PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 11/02/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 PHILIPSBURG BIGLER HWY
PHILIPSBURG PA
16866-8251
US

IV. Provider business mailing address

127 PA-106
GREENFIELD TOWNSHIP PA
18407-8142
US

V. Phone/Fax

Practice location:
  • Phone: 814-343-7373
  • Fax: 615-825-4178
Mailing address:
  • Phone: 570-282-5189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP023965
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: