Provider Demographics
NPI:1801547138
Name:YARNELL, BREANNA RENEE (CRNP)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:RENEE
Last Name:YARNELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3958 BROWN PARK DR STE D
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1160
Mailing Address - Country:US
Mailing Address - Phone:570-772-8723
Mailing Address - Fax:
Practice Address - Street 1:700 MONROE RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1409
Practice Address - Country:US
Practice Address - Phone:513-932-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0037235363LF0000X
PASP025364363L00000X
PARN651468163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1040004500001Medicaid
PA2B0710OtherMECICARE