Provider Demographics
NPI:1497831184
Name:YODER, BRENT RICHARD (CRNP)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:RICHARD
Last Name:YODER
Suffix:
Gender:M
Credentials:CRNP
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 997
Mailing Address - Street 2:
Mailing Address - City:FLOMATON
Mailing Address - State:AL
Mailing Address - Zip Code:36441-0997
Mailing Address - Country:US
Mailing Address - Phone:251-296-2456
Mailing Address - Fax:251-296-0320
Practice Address - Street 1:174 HWY 113
Practice Address - Street 2:
Practice Address - City:FLOMATON
Practice Address - State:AL
Practice Address - Zip Code:36441
Practice Address - Country:US
Practice Address - Phone:251-296-2456
Practice Address - Fax:251-296-0320
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1089948363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily