Provider Demographics
NPI:1538944830
Name:YARBROUGH-YALE, KELLEY RENEE' (DNP, APRN, ACCNS-AG)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:RENEE'
Last Name:YARBROUGH-YALE
Suffix:
Gender:F
Credentials:DNP, APRN, ACCNS-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7825 ARNOLD TER
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7307
Mailing Address - Country:US
Mailing Address - Phone:817-368-5565
Mailing Address - Fax:
Practice Address - Street 1:1500 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4917
Practice Address - Country:US
Practice Address - Phone:817-702-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135676364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
22200425OtherCERTIFIED DIABETES CARE & EDUCATION SPECIALIST (CDCES)