Provider Demographics
NPI:1669977799
Name:YELVERTON, FORREST (ATS)
Entity type:Individual
Prefix:
First Name:FORREST
Middle Name:
Last Name:YELVERTON
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 W ROYAL LN APT 306
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-6014
Mailing Address - Country:US
Mailing Address - Phone:806-277-0311
Mailing Address - Fax:
Practice Address - Street 1:701 S NEDDERMAN DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76019-9800
Practice Address - Country:US
Practice Address - Phone:817-272-6735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer