Provider Demographics
NPI:1962934802
Name:YARBROUGH, BRIANA
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:YARBROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 E TROPICANA AVE # 175B
Mailing Address - Street 2:1455 E TROPICANA AVE # 175B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6507
Mailing Address - Country:US
Mailing Address - Phone:702-893-2001
Mailing Address - Fax:702-369-3334
Practice Address - Street 1:1455 E TROPICANA AVE # 175B
Practice Address - Street 2:1455 E TROPICANA AVE # 175B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6507
Practice Address - Country:US
Practice Address - Phone:702-893-2001
Practice Address - Fax:702-369-3334
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NV225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator