Provider Demographics
NPI:1558130732
Name:YEARY, MARDI JO
Entity Type:Individual
Prefix:MRS
First Name:MARDI
Middle Name:JO
Last Name:YEARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 AMERICAN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4066
Mailing Address - Country:US
Mailing Address - Phone:661-833-4483
Mailing Address - Fax:661-833-4481
Practice Address - Street 1:4600 AMERICAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-4066
Practice Address - Country:US
Practice Address - Phone:661-833-4483
Practice Address - Fax:661-833-4481
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator