Provider Demographics
NPI:1457711293
Name:YEAGER, EMILY ANN
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:YEAGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:CHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1403 RESERVE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5660
Mailing Address - Country:US
Mailing Address - Phone:318-267-9298
Mailing Address - Fax:
Practice Address - Street 1:312 GRAMMONT ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7457
Practice Address - Country:US
Practice Address - Phone:318-388-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN128575367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered