Provider Demographics
NPI:1316933112
Name:YINGER, JACQUELINE CAROL (CPNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CAROL
Last Name:YINGER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2696
Mailing Address - Country:US
Mailing Address - Phone:614-722-4554
Mailing Address - Fax:614-722-4565
Practice Address - Street 1:555 S 18TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2696
Practice Address - Country:US
Practice Address - Phone:614-722-4554
Practice Address - Fax:614-722-4565
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN102601 NP03086363LP0200X
OHCOA03086363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2567646Medicaid
KY78014040Medicaid
Q37300Medicare UPIN
KY78014040Medicaid