Provider Demographics
NPI:1851079966
Name:YEAGLEY, HOLLY MARIE (CPNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:MARIE
Last Name:YEAGLEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 RIDGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-1979
Mailing Address - Country:US
Mailing Address - Phone:618-567-7308
Mailing Address - Fax:
Practice Address - Street 1:7200 POE AVE STE 201
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45414
Practice Address - Country:US
Practice Address - Phone:937-236-5396
Practice Address - Fax:800-709-6956
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.003409363LP0200X
OHAPRN.CNP.0034309363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics