Provider Demographics
NPI:1194776831
Name:YEARY, MARTHA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ANNE
Last Name:YEARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:ANNE
Other - Last Name:YEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1780
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-6780
Mailing Address - Country:US
Mailing Address - Phone:270-384-0233
Mailing Address - Fax:270-384-0245
Practice Address - Street 1:805 BURKESVILLE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1655
Practice Address - Country:US
Practice Address - Phone:270-384-0233
Practice Address - Fax:270-384-0245
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33351207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64333511Medicaid
KYK008391OtherGROUP PTAN
KY33351OtherLICENSE