Healthcare Provider Details

I. General information

NPI: 1740750561
Provider Name (Legal Business Name): JOAN YARDLEY A.P. R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 N 100 W
BEAVER UT
84713-7758
US

IV. Provider business mailing address

PO BOX 1690
BEAVER UT
84713-1690
US

V. Phone/Fax

Practice location:
  • Phone: 435-438-7280
  • Fax:
Mailing address:
  • Phone: 435-438-7284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7357490-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: