Provider Demographics
NPI:1528154325
Name:YEASAYER, MICHELLE EGAR (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:EGAR
Last Name:YEASAYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7835
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:227 FALCON DR STE 104
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9792
Practice Address - Country:US
Practice Address - Phone:859-497-5459
Practice Address - Fax:859-497-5470
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA055363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4000501OtherMEDICARE LAB GROUP
KY95005138Medicaid
KYCB5773OtherRR MEDICARE GROUP
KYP00245022OtherRR MEDICARE PIN
KY37903705OtherMEDICAID GROUP LAB
KY37903705OtherMEDICAID GROUP LAB
KYCB5773OtherRR MEDICARE GROUP