Provider Demographics
NPI:1346320421
Name:YANCEY, BECKY JO (PA)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:JO
Last Name:YANCEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:JO
Other - Last Name:FRITCHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:6983 HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2054
Mailing Address - Country:US
Mailing Address - Phone:317-308-2828
Mailing Address - Fax:317-576-6311
Practice Address - Street 1:1400 N RITTER AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3052
Practice Address - Country:US
Practice Address - Phone:317-355-1555
Practice Address - Fax:317-355-1108
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000661A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000603804OtherANTHEM
IN000000603804OtherANTHEM