Provider Demographics
NPI:1720859853
Name:YANCEY, DANIELLE L
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:L
Last Name:YANCEY
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 1:2000 E LAMAR BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-7361
Mailing Address - Country:US
Mailing Address - Phone:817-837-0977
Mailing Address - Fax:817-467-8002
Practice Address - Street 1:370 N STATE HIGHWAY 360 APT 6303
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9033
Practice Address - Country:US
Practice Address - Phone:214-718-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0224393747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1215648449Medicaid
TX468301301Medicaid