Provider Demographics
NPI:1740750561
Name:YARDLEY, JOAN (AP RN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:YARDLEY
Suffix:
Gender:F
Credentials:AP RN
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 1690
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:UT
Mailing Address - Zip Code:84713-1690
Mailing Address - Country:US
Mailing Address - Phone:435-438-7284
Mailing Address - Fax:
Practice Address - Street 1:1059 N 100 W
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:UT
Practice Address - Zip Code:84713-7758
Practice Address - Country:US
Practice Address - Phone:435-438-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7357490-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner