Provider Demographics
NPI:1205328739
Name:YOAKUM, MICHAEL (CNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:YOAKUM
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-3723
Mailing Address - Country:US
Mailing Address - Phone:937-657-4467
Mailing Address - Fax:
Practice Address - Street 1:1149 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-3723
Practice Address - Country:US
Practice Address - Phone:937-657-4467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022803363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health