Provider Demographics
NPI:1225389133
Name:YAWN, VANESSA T (PA-C)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:T
Last Name:YAWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2559 WESTERN TRAILS BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1569
Mailing Address - Country:US
Mailing Address - Phone:512-815-2559
Mailing Address - Fax:512-318-2538
Practice Address - Street 1:2559 WESTERN TRAILS BLVD STE 301
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1569
Practice Address - Country:US
Practice Address - Phone:512-815-2559
Practice Address - Fax:512-318-2538
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363AM0700X
TXPA10267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical