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General NPI Number Information
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NPI Number | 1356347215
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Entity Type | Individual
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Provider Name | MARK ANTHONY YACKLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 2101 N WALDRON ST
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City | HUTCHINSON
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State | KS
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Zip | 67502-1131
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Country | US
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Telephone | 620-669-2500
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Fax | 620-669-2598
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Provider Business Mailing Address
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Address Line | 2101 N WALDRON ST
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City | HUTCHINSON
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State | KS
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Zip | 67502-1131
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Country | US
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Telephone | 620-669-2500
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Fax | 620-694-2005
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 32631-020
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 04-31842
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 04-31842
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License Number State | KS
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