Healthcare Provider Details

I. General information

NPI: 1952839771
Provider Name (Legal Business Name): KAILEY IMLAY YANCEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 LEONARD AVE BLDG 22ND
WASHINGTON PA
15301-3368
US

IV. Provider business mailing address

95 LEONARD AVENUE BUILDING 2 2ND FLOOR
WASHINGTON PA
15301
US

V. Phone/Fax

Practice location:
  • Phone: 724-223-3100
  • Fax: 724-223-3353
Mailing address:
  • Phone: 724-223-3100
  • Fax: 724-223-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT213245
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: