Individual
MRS. JOHNNA KAYE YEALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
930 MADISON AVE, SUITE 890, MEMPHIS, TN 38103-3410
(901) 866-8834
(901) 302-2834
Mailing address
2157 IDLEWOOD CV, GERMANTOWN, TN 38139-5316
(615) 970-9212
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1377
TN
363A00000X
Physician Assistant
TC 015
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA1377
TN STATE LICENSE
TN
Enumeration date
08/31/2006
Last updated
01/30/2015
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