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General NPI Number Information
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NPI Number | 1447553938
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Entity Type | Individual
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Provider Name | KEVIN ALLEN YACKLEY CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 801 E SIOUX AVE
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City | PIERRE
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State | SD
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Zip | 57501
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Country | US
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Telephone | 605-224-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S 9TH ST
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City | ONIDA
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State | SD
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Zip | 57564-2133
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Country | US
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Telephone | 605-222-1912
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R49835
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CR001021
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License Number State | SD
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