Healthcare Provider Details

I. General information

NPI: 1023744638
Provider Name (Legal Business Name): JULIA ALEXANDRA YEAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4491 LONG PRAIRIE RD UNIT 300
FLOWER MOUND TX
75028-1795
US

IV. Provider business mailing address

1451 CENTRE PLACE DR APT 401
DENTON TX
76205-1213
US

V. Phone/Fax

Practice location:
  • Phone: 469-687-9184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: