Provider Demographics
NPI:1255608212
Name:YANCEY, JACQUELINE D (DO)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:D
Last Name:YANCEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5375 WILLIAM FLYNN HWY
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-9666
Mailing Address - Country:US
Mailing Address - Phone:724-449-3245
Mailing Address - Fax:724-449-3233
Practice Address - Street 1:5375 WILLIAM FLYNN HWY
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9666
Practice Address - Country:US
Practice Address - Phone:724-449-3245
Practice Address - Fax:724-449-3233
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016465207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102824975Medicaid
PA102824975Medicaid