Provider Demographics
NPI:1982685368
Name:YEAGER, KELLY RENE' (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:RENE'
Last Name:YEAGER
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:U.T. HEARING AND SPEECH CENTER
Mailing Address - Street 2:1600 PEYTON MANNING PASS
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37996-0001
Mailing Address - Country:US
Mailing Address - Phone:865-974-5451
Mailing Address - Fax:865-974-4639
Practice Address - Street 1:U.T. HEARING AND SPEECH CENTER
Practice Address - Street 2:1600 PEYTON MANNING PASS
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37996-0001
Practice Address - Country:US
Practice Address - Phone:865-974-5451
Practice Address - Fax:865-974-4639
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001192237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3966921Medicare ID - Type UnspecifiedPART B