Provider Demographics
NPI:1912030867
Name:PHILLIP BURRESS YARBROUGH, FNP-C, PLLC
Entity Type:Organization
Organization Name:PHILLIP BURRESS YARBROUGH, FNP-C, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:BURRESS
Authorized Official - Last Name:YARBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:254-248-1920
Mailing Address - Street 1:3945 W US HIGHWAY 84
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-3718
Mailing Address - Country:US
Mailing Address - Phone:254-248-1920
Mailing Address - Fax:
Practice Address - Street 1:3945 W US HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-3718
Practice Address - Country:US
Practice Address - Phone:254-248-1920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B6518Medicare ID - Type Unspecified