Healthcare Provider Details

I. General information

NPI: 1447553938
Provider Name (Legal Business Name): KEVIN ALLEN YACKLEY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E SIOUX AVE
PIERRE SD
57501
US

IV. Provider business mailing address

601 S 9TH ST
ONIDA SD
57564-2133
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-3100
  • Fax:
Mailing address:
  • Phone: 605-222-1912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR49835
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR001021
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: