MEDICARE: MRS. KELSIE LEEANNE YANG PA-C

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	363AS0400X	Surgical Physician Assistant	PA9104035	FL

General Provider Information

NPI Number	:	1134371271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KELSIE LEEANNE YANG PA-C

Provider Business Mailing Address
First Line	:	907 MAR WALT DR
Second Line	:	SUITE 2024
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6960
Country	:	US
Telephone Number	:	850-243-2229
Fax Number	:	850-862-0124

Provider Business Practice Location Address
First Line	:	907 MAR WALT DR
Second Line	:	SUITE 2024
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-6960
Country	:	US
Telephone Number	:	850-243-2229
Fax Number	:	850-862-0124

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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