Provider Demographics
NPI:1871568014
Name:YASUI, ROBERT R (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:R
Last Name:YASUI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8187
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37352-8187
Mailing Address - Country:US
Mailing Address - Phone:931-695-5466
Mailing Address - Fax:
Practice Address - Street 1:40 LYNCHBURG HWY
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:TN
Practice Address - Zip Code:37352-7449
Practice Address - Country:US
Practice Address - Phone:931-759-4197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA200363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0443866Medicaid
103I973015Medicare PIN
TN0443866Medicaid