Provider Demographics
NPI:1952669202
Name:YEARGIN, DEDERICK ALAN (ANP)
Entity Type:Individual
Prefix:
First Name:DEDERICK
Middle Name:ALAN
Last Name:YEARGIN
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 GENERAL GEORGE PATTON DR
Mailing Address - Street 2:STE. 107
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-4606
Mailing Address - Country:US
Mailing Address - Phone:615-891-2309
Mailing Address - Fax:
Practice Address - Street 1:1881 GENERAL GEORGE PATTON DR
Practice Address - Street 2:107
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-4606
Practice Address - Country:US
Practice Address - Phone:615-829-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16913363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner