Provider Demographics
NPI:1053483511
Name:YARBROUGH, ANNA KRISTINA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KRISTINA
Last Name:YARBROUGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:KRISTINA
Other - Last Name:ARREDONDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:12221 MERIT DR
Mailing Address - Street 2:SUITE 1610
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2202
Mailing Address - Country:US
Mailing Address - Phone:972-372-0912
Mailing Address - Fax:214-217-1901
Practice Address - Street 1:12221 MERIT DR
Practice Address - Street 2:SUITE 1610
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2202
Practice Address - Country:US
Practice Address - Phone:972-372-0912
Practice Address - Fax:214-217-1901
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04592363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y2083OtherBCBS
TX3008559-01Medicaid
TX3008559-01Medicaid
TXTXB156227Medicare PIN
TXP00420142Medicare PIN
Q79576Medicare UPIN