Healthcare Provider Details

I. General information

NPI: 1598319105
Provider Name (Legal Business Name): EILEEN HOYLE YEARWOOD PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 VICTORY GROUP WAY STE 305
FRISCO TX
75034-6722
US

IV. Provider business mailing address

3535 VICTORY GROUP WAY STE 305
FRISCO TX
75034-6722
US

V. Phone/Fax

Practice location:
  • Phone: 469-333-1543
  • Fax:
Mailing address:
  • Phone: 972-324-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP142327
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: