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NPI Code Detail

MEDICARE: MRS. CRYSTAL YEAGER PA

MEDICARE: MRS. CRYSTAL YEAGER PA
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
1363AM0700XMedical Physician AssistantPA792KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00648835OTHERRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000000522080OTHERKYANTHEM BCBS

General Provider Information

NPI Number : 1356389514
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CRYSTAL YEAGER PA
Provider Business Mailing Address
First Line : 509 MEMORIAL DR
Second Line : STE 2
City : MANCHESTER
State : KY
Zip : 40962-6196
Country : US
Telephone Number : 606-598-8813
Fax Number : 606-598-1688
Provider Business Practice Location Address
First Line : 56 MARIE LANGDON DR
Second Line :
City : MANCHESTER
State : KY
Zip : 40962-6329
Country : US
Telephone Number : 606-599-4080
Fax Number : 606-598-1688
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2006
Last Update Date : 06/18/2025

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Directions to “ MRS. CRYSTAL YEAGER PA” Practice Location

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