Provider Demographics
NPI:1689043283
Name:YARBROUGH, JEFFREY BRYAN (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:BRYAN
Last Name:YARBROUGH
Suffix:
Gender:M
Credentials: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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:1302 N PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-1022
Practice Address - Country:US
Practice Address - Phone:903-569-5383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129106363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-0818167-022OtherTRICARE
TX75-2616977-002OtherTRICARE
TXP01636584OtherRAIL ROAD MEDICARE
TX75-2616977-043OtherTRICARE
TXP01569234OtherRAIL ROAD MEDICARE
TX75-2616977-001OtherTRICARE
TX75-2616977-028OtherTRICARE
TX353937101Medicaid
TX353937102Medicaid
TX8251NSOtherBCBS
TX8469NVOtherBCBS
TX353937101Medicaid
TX75-2616977-002OtherTRICARE