Healthcare Provider Details

I. General information

NPI: 1194357368
Provider Name (Legal Business Name): TAYLOR ANN YEAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HIGH ST
FARMVILLE VA
23909-1800
US

IV. Provider business mailing address

10417 FALCONBRIDGE DR
RICHMOND VA
23238-3844
US

V. Phone/Fax

Practice location:
  • Phone: 434-395-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: