Provider Demographics
NPI:1780050013
Name:YELVERTON, ANGELIA JEAN (FNP)
Entity type:Individual
Prefix:MRS
First Name:ANGELIA
Middle Name:JEAN
Last Name:YELVERTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:ANGELIA
Other - Middle Name:JEAN
Other - Last Name:WHITEHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:109 ROSEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-9730
Mailing Address - Country:US
Mailing Address - Phone:601-668-1574
Mailing Address - Fax:
Practice Address - Street 1:1055 MENDELL DAVIS DR
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-9788
Practice Address - Country:US
Practice Address - Phone:601-371-6098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS859301363L00000X
MSF0215090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner