Provider Demographics
NPI:1568020097
Name:YOST, COREY RYAN (PA-C)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:RYAN
Last Name:YOST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 PLEASANT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1424
Mailing Address - Country:US
Mailing Address - Phone:515-282-2921
Mailing Address - Fax:
Practice Address - Street 1:411 LAUREL ST STE A300
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3030
Practice Address - Country:US
Practice Address - Phone:515-282-2921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA097541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty