Individual
BLAYNE O YERBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1419 S 6TH ST, MACCLENNY, FL 32063-4624
(904) 653-1822
(904) 259-1225
Mailing address
789 W DUVAL ST, LAKE CITY, FL 32055-3811
(386) 755-5044
(386) 755-2283
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
9110127
FL
363A00000X
Physician Assistant
Primary
PA9110127
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020253400
—
FL
Enumeration date
03/08/2017
Last updated
02/12/2021
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