Provider Demographics
NPI:1710635859
Name:CRIGLAR, YANNIQUE DANYELLE
Entity Type:Individual
Prefix:
First Name:YANNIQUE
Middle Name:DANYELLE
Last Name:CRIGLAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 N HILLS ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-1730
Mailing Address - Country:US
Mailing Address - Phone:601-604-3260
Mailing Address - Fax:
Practice Address - Street 1:200 S LAMAR ST STE N400
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39201-4013
Practice Address - Country:US
Practice Address - Phone:601-604-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS324508164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse