Healthcare Provider Details

I. General information

NPI: 1962033480
Provider Name (Legal Business Name): SHAMETRA LAKAY YEAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 WESTWAY PL
ARLINGTON TX
76018-5245
US

IV. Provider business mailing address

320 WESTWAY PL
ARLINGTON TX
76018-5245
US

V. Phone/Fax

Practice location:
  • Phone: 817-516-9100
  • Fax:
Mailing address:
  • Phone: 817-516-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: