Provider Demographics
NPI:1477026219
Name:YAWGER, KELLY LYNN
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:YAWGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 E SHORE TRL
Mailing Address - Street 2:
Mailing Address - City:SANDYSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07826-5018
Mailing Address - Country:US
Mailing Address - Phone:570-534-2071
Mailing Address - Fax:
Practice Address - Street 1:26 DOOLAN ROAD
Practice Address - Street 2:
Practice Address - City:DINGMANS FERRY
Practice Address - State:PA
Practice Address - Zip Code:18360
Practice Address - Country:US
Practice Address - Phone:570-534-2971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist