MEDICARE: LISA YARBOROUGH ANTHONY N.P.

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	901585	MS

General Provider Information

NPI Number	:	1841642733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA YARBOROUGH ANTHONY N.P.

Provider Business Mailing Address
First Line	:	952 GREEN MEADOW RD
Second Line	:
City	:	BAY SAINT LOUIS
State	:	MS
Zip	:	39520-1620
Country	:	US
Telephone Number	:	228-463-1649
Fax Number	:	228-463-0138

Provider Business Practice Location Address
First Line	:	952 GREEN MEADOW RD
Second Line	:
City	:	BAY SAINT LOUIS
State	:	MS
Zip	:	39520-1620
Country	:	US
Telephone Number	:	228-463-1649
Fax Number	:	228-463-0138

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

Provider Enumeration Date	:	07/05/2016
Last Update Date	:	11/08/2021

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