Provider Demographics
NPI:1619063146
Name:YASSO, BARBARA RUTH (PNP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:RUTH
Last Name:YASSO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S OLD ORCHARD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4370
Mailing Address - Country:US
Mailing Address - Phone:972-436-7962
Mailing Address - Fax:972-420-0085
Practice Address - Street 1:502 S OLD ORCHARD
Practice Address - Street 2:SUITE 126
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4370
Practice Address - Country:US
Practice Address - Phone:972-436-7962
Practice Address - Fax:972-353-5780
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX527307363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122014704Medicaid