Provider Demographics
NPI:1023303906
Name:YOARS, JACQUELINE (CRNA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:YOARS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 BROOKS BRIDGE XING
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6335 HOSPITAL PKWY
Practice Address - Street 2:SUITE 304
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1549
Practice Address - Country:US
Practice Address - Phone:404-778-8317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-18
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9235120367500000X
GARN256769367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01045892OtherRAILROAD MEDICARE
FL0038303 00Medicaid
XXX-XX-7185OtherCHAMPUS / TRICARE (SOUTH REGION)
FLG00SROtherBCBS
FL0038303 00Medicaid