Provider Demographics
NPI:1447701099
Name:YEARGANS, JOHNETTA
Entity type:Individual
Prefix:
First Name:JOHNETTA
Middle Name:
Last Name:YEARGANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOHNETTA
Other - Middle Name:
Other - Last Name:YEARGANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:7932 N ANITA DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-1200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7932 N ANITA DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-1200
Practice Address - Country:US
Practice Address - Phone:816-462-4226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003010983164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse