Provider Demographics
NPI:1649589649
Name:YEATTS, JESSICA LYNN (LVN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:YEATTS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31270 YOSEMITE SPRINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:COARSEGOLD
Mailing Address - State:CA
Mailing Address - Zip Code:93614-9579
Mailing Address - Country:US
Mailing Address - Phone:559-676-0740
Mailing Address - Fax:
Practice Address - Street 1:31270 YOSEMITE SPRINGS PKWY
Practice Address - Street 2:
Practice Address - City:COARSEGOLD
Practice Address - State:CA
Practice Address - Zip Code:93614-9579
Practice Address - Country:US
Practice Address - Phone:559-676-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-26
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN220428164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse