MEDICARE: BRENT RICHARD YODER CRNP

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	363LF0000X	Family Nurse Practitioner	1089948	AL

General Provider Information

NPI Number	:	1497831184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT RICHARD YODER CRNP

Provider Business Mailing Address
First Line	:	PO BOX 997
Second Line	:
City	:	FLOMATON
State	:	AL
Zip	:	36441-0997
Country	:	US
Telephone Number	:	251-296-2456
Fax Number	:	251-296-0320

Provider Business Practice Location Address
First Line	:	174 HWY 113
Second Line	:
City	:	FLOMATON
State	:	AL
Zip	:	36441
Country	:	US
Telephone Number	:	251-296-2456
Fax Number	:	251-296-0320

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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