Provider Demographics
NPI:1619545647
Name:YEASTER, DAKOTA JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:JAMES
Last Name:YEASTER
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 1:720 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-9609
Mailing Address - Country:US
Mailing Address - Phone:269-781-6600
Mailing Address - Fax:
Practice Address - Street 1:720 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-9609
Practice Address - Country:US
Practice Address - Phone:269-781-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program