Healthcare Provider Details

I. General information

NPI: 1558898163
Provider Name (Legal Business Name): SUSAN YARBOROUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MOUSE CREEK RD NW
CLEVELAND TN
37312-3840
US

IV. Provider business mailing address

170 MOUSE CREEK RD NW
CLEVELAND TN
37312-3840
US

V. Phone/Fax

Practice location:
  • Phone: 423-458-1426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number36207
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: