Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 04-31842 | KS |
Y | 111NI0900X | Internist | 04-31842 | KS |
N | 207R00000X | Internist | 32631-020 | WI |
N | 111NI0900X | Internist | 32631-020 | WI |
N | 207RH0002X | Hospice and Palliative Medicine | 04-31842 | KS |
NPI | 1356347215 |
---|---|
Provider Name | Dr. Mark Anthony Yackley |
First Address | Hutchinson, KS 67502-1131 |
Second Address | Hutchinson, KS 67502-1131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 23/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200373750 | (05) | KS |
F46681 | (02) |