Provider Demographics
NPI:1457508301
Name:YAWN, LINDA JOSEFINE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JOSEFINE
Last Name:YAWN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:KELLOGG
Mailing Address - State:ID
Mailing Address - Zip Code:83837-0442
Mailing Address - Country:US
Mailing Address - Phone:208-783-0300
Mailing Address - Fax:208-783-0303
Practice Address - Street 1:107 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2501
Practice Address - Country:US
Practice Address - Phone:208-783-0300
Practice Address - Fax:208-783-0303
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID56803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1235797838Medicaid