Healthcare Provider Details

I. General information

NPI: 1801148085
Provider Name (Legal Business Name): MEAGAN LYNN YEATES RN, MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 W BLUFF ST
WOODVILLE TX
75979-5131
US

IV. Provider business mailing address

PO BOX 402
JASPER TX
75951-0005
US

V. Phone/Fax

Practice location:
  • Phone: 409-200-2811
  • Fax: 409-200-2856
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number744263
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: