Individual
KACIE JONES YEAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
2500 NORTH STATE STREET, RALEIGH, MS 39153-0429
(601) 818-6732
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R869339
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05155267
—
MS
01
—
P01572994
RAILROAD MEDICARE
MS
Enumeration date
01/10/2011
Last updated
02/16/2016
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