Provider Demographics
NPI:1083133417
Name:YANDLE, JILL REBECCA (AGNP-C)
Entity Type:Individual
Prefix:MISS
First Name:JILL
Middle Name:REBECCA
Last Name:YANDLE
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-264-3500
Mailing Address - Fax:704-264-1393
Practice Address - Street 1:1401 MATTHEWS TOWNSHIP PKWY STE 110
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105
Practice Address - Country:US
Practice Address - Phone:704-264-3500
Practice Address - Fax:704-264-1393
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCYAND-15X4Y2363L00000X
NC5009884363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner