MEDICARE: STEVEN WILLIAM YETTON ATC, LAT, PARAMEDIC

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	2255A2300X	Athletic Trainer	2000032043
2	146L00000X	Paramedic	P116835	NC

General Provider Information

NPI Number	:	1710426101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN WILLIAM YETTON ATC, LAT, PARAMEDIC

Provider Business Mailing Address
First Line	:	95 CENTRAL AVE
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023-2304
Country	:	US
Telephone Number	:	803-457-2471
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 CENTRAL AVE
Second Line	:
City	:	CHINA GROVE
State	:	NC
Zip	:	28023-2304
Country	:	US
Telephone Number	:	803-457-2471
Fax Number	:

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

Provider Enumeration Date	:	02/17/2017
Last Update Date	:	02/21/2020

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