Provider Demographics
NPI:1033443700
Name:CAO, YAN
Entity type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:CAO
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 1:2323 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-7747
Mailing Address - Country:US
Mailing Address - Phone:903-597-1351
Mailing Address - Fax:903-535-7384
Practice Address - Street 1:575 W STATE HIGHWAY 243
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-2113
Practice Address - Country:US
Practice Address - Phone:903-567-4197
Practice Address - Fax:903-535-7384
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX859245363L00000X
WI3845-33363L00000X, 363LP0808X
TXAP125462363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX333052403Medicaid