Provider Demographics
NPI:1720098841
Name:YEOMANS SCHAEFER, KARASSA DAWN (PAC)
Entity Type:Individual
Prefix:
First Name:KARASSA
Middle Name:DAWN
Last Name:YEOMANS SCHAEFER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:KARASSA
Other - Middle Name:DAWN
Other - Last Name:HORROCKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1305 ESCALANTE DRIVE
Mailing Address - Street 2:UNIT 205
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303
Mailing Address - Country:US
Mailing Address - Phone:970-259-1971
Mailing Address - Fax:970-259-4036
Practice Address - Street 1:1305 ESCALANTE DRIVE
Practice Address - Street 2:UNIT 205
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303
Practice Address - Country:US
Practice Address - Phone:970-259-1971
Practice Address - Fax:970-259-4036
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0021363A00000X
CAPA18376363A00000X
WI2070363A00000X
CO1739363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MY1689124OtherDEA
Q04528Medicare UPIN