MEDICARE: JENNIFER YEAGER RN CP NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	715547	TX
2	363LP0200X	Pediatric Nurse Practitioner	AP116811	TX

General Provider Information

NPI Number	:	1033347786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER YEAGER RN CP NP

Provider Business Mailing Address
First Line	:	5801 W WADLEY AVE
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-5055
Country	:	US
Telephone Number	:	432-699-2636
Fax Number	:	432-699-4134

Provider Business Practice Location Address
First Line	:	5801 W WADLEY AVE
Second Line	:
City	:	MIDLAND
State	:	TX
Zip	:	79707-5055
Country	:	US
Telephone Number	:	432-699-2636
Fax Number	:	432-699-4134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	01/22/2021

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