Provider Demographics
NPI:1508679572
Name:YEAGER, KAITLYNN AUTUMN
Entity type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:AUTUMN
Last Name:YEAGER
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 1:19609 FILLY DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-3471
Mailing Address - Country:US
Mailing Address - Phone:405-803-3693
Mailing Address - Fax:
Practice Address - Street 1:425 S FRETZ AVE STE C
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-5568
Practice Address - Country:US
Practice Address - Phone:405-757-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No374700000XNursing Service Related ProvidersTechnician