Provider Demographics
NPI:1962611129
Name:YARNALL, CRYSTAL J (NP)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:J
Last Name:YARNALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:J
Other - Last Name:HEACOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7668 WINDY RDG
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-8440
Mailing Address - Country:US
Mailing Address - Phone:563-582-3767
Mailing Address - Fax:
Practice Address - Street 1:4036 S 6TH ST STE 2
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4750
Practice Address - Country:US
Practice Address - Phone:541-851-9320
Practice Address - Fax:541-851-9322
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA109002163W00000X
IAA156728363LF0000X
OR202100029NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35011400Medicaid