Provider Demographics
NPI:1871328104
Name:YAGGY, BREANNA LEIGH
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:LEIGH
Last Name:YAGGY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 BRANSON LANDING BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-2140
Mailing Address - Country:US
Mailing Address - Phone:417-335-7558
Mailing Address - Fax:
Practice Address - Street 1:525 BRANSON LANDING BLVD STE 306
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2140
Practice Address - Country:US
Practice Address - Phone:417-335-3558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024036238363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care