Provider Demographics
NPI:1922558865
Name:YAN, CLYDE H (PMHNP)
Entity type:Individual
Prefix:
First Name:CLYDE
Middle Name:H
Last Name:YAN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9245 N MERIDIAN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1832
Mailing Address - Country:US
Mailing Address - Phone:317-818-9000
Mailing Address - Fax:317-818-9009
Practice Address - Street 1:9245 N MERIDIAN ST STE 300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1832
Practice Address - Country:US
Practice Address - Phone:317-818-9000
Practice Address - Fax:317-818-9009
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006551A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health