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General NPI Number Information
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NPI Number | 1154886778
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Entity Type | Individual
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Provider Name | SYDNEE NICOLE YANCEY DPT, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 106 E LUCAS ST
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City | KNOB NOSTER
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State | MO
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Zip | 65336-1134
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Country | US
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Telephone | 660-563-9800
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Fax | 660-563-9801
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Provider Business Mailing Address
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Address Line | 106 E LUCAS ST
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City | KNOB NOSTER
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State | MO
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Zip | 65336-1134
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Country | US
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Telephone | 660-563-9800
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Fax | 660-563-9801
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2021034464
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2024023402
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License Number State | MO
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