Provider Demographics
NPI:1366471518
Name:YANCEY, BERYL GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:BERYL
Middle Name:GAIL
Last Name:YANCEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 CHERE CAROL RD
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-3638
Mailing Address - Country:US
Mailing Address - Phone:731-784-0064
Mailing Address - Fax:731-784-7358
Practice Address - Street 1:3511 CHERE CAROL RD
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-3638
Practice Address - Country:US
Practice Address - Phone:731-784-0064
Practice Address - Fax:731-784-7358
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20060174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507997Medicaid
TN30482401Medicare PIN
TNE51181Medicare UPIN
TN1507997Medicaid