Provider Demographics
NPI:1639732530
Name:MCKELROY, YOSTIN ZAMBRANO (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:YOSTIN
Middle Name:ZAMBRANO
Last Name:MCKELROY
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7651 TCHULAHOMA RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9227
Mailing Address - Country:US
Mailing Address - Phone:662-349-0980
Mailing Address - Fax:
Practice Address - Street 1:3446 POPPS FERRY RD
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-2421
Practice Address - Country:US
Practice Address - Phone:228-397-2494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141317363LF0000X
MS903163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty