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General NPI Number Information
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NPI Number | 1851079966
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Entity Type | Individual
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Provider Name | HOLLY MARIE YEAGLEY CPNP
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Gender | Female
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 7200 POE AVE STE 201
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City | VANDALIA
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State | OH
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Zip | 45414
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Country | US
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Telephone | 937-236-5396
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Fax | 800-709-6956
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Provider Business Mailing Address
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Address Line | 3625 RIDGEWAY RD
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City | BELLBROOK
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State | OH
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Zip | 45305-1979
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Country | US
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Telephone | 618-567-7308
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN.CNP.003409
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN.CNP.0034309
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License Number State | OH
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