Provider Demographics
NPI:1598704538
Name:YARD, JEAN NICOLE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:NICOLE
Last Name:YARD
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 PRIDGENFARM RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-7604
Mailing Address - Country:US
Mailing Address - Phone:703-868-3667
Mailing Address - Fax:
Practice Address - Street 1:2130 PRIDGENFARM RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-7604
Practice Address - Country:US
Practice Address - Phone:703-868-3667
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer