Individual
KENNETH PAUL YEAGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2100 N DR MARTIN LUTHER KING JR BLVD, CLOVIS, NM 88101-9412
(573) 686-5550
(573) 686-2139
Mailing address
4901 GRANDE DR, PENSACOLA, FL 32504-8965
(850) 477-7042
(850) 474-9060
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
ARNP2027442
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
R61693
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
28405251
—
NM
01
—
59059908
BLUE CROSS & BLUE SHIELD
AL
01
—
G1108
BLUE CROSS & BLUE SHIELD
FL
01
—
P00431700
RAILROAD MEDICARE
NM
Enumeration date
08/15/2005
Last updated
04/04/2008
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