Provider Demographics
NPI:1306519517
Name:YANCEY, ETTA MARIA (FNP-C)
Entity type:Individual
Prefix:
First Name:ETTA
Middle Name:MARIA
Last Name:YANCEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8742 GOODWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7915
Mailing Address - Country:US
Mailing Address - Phone:985-688-8970
Mailing Address - Fax:
Practice Address - Street 1:37488 SEVEN OAKS AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4355
Practice Address - Country:US
Practice Address - Phone:198-568-8897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA221209363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner