Holly Marie Yeagley, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

APRN.CNP.0034309 Issued in OH

Practice address

7200 Poe Ave Ste 201
Vandalia, OH 45414

Phone

(937) 236-5396

Fax

(800) 709-6956

NPI assigned

Jul 10, 2023

Last updated

Jul 10, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Five Rivers Health Centers

  • Family Medicine Physician
  • Dayton, OH
  • NPI 1669143061
  Medicare reassignment
• Five Rivers Health Centers

  • Family Medicine Physician
  • Dayton, OH
  • NPI 1053600775
  NPD
• Five Rivers Health Centers

  • Family Medicine Physician
  • Xenia, OH
  • NPI 1083501415
  NPD
• Five Rivers Health Centers

  • Family Medicine Physician
  • Xenia, OH
  • NPI 1124563796
  NPD
• Ohio Pediatrics, Inc.

  • Pediatrics Physician
  • Kettering, OH
  • NPI 1619090750
  NPD (past)
• Ohio Pediatrics, Inc.

  • Pediatrics Physician
  • Vandalia, OH
  • NPI 1699921932
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1851079966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3625 RIDGEWAY RD",
            "city": "BELLBROOK",
            "state": "OH",
            "postal_code": "453051979",
            "telephone_number": "618-567-7308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7200 POE AVE STE 201",
            "city": "VANDALIA",
            "state": "OH",
            "postal_code": "45414",
            "telephone_number": "937-236-5396",
            "fax_number": "800-709-6956"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1775 Delco Park Dr",
            "address_purpose": "LOCATION",
            "city": "Kettering",
            "state": "OH",
            "postal_code": "454201398",
            "country_code": "US",
            "telephone_number": "937-299-2339",
            "fax_number": "800-587-5027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YEAGLEY",
        "first_name": "HOLLY",
        "middle_name": "MARIE",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OH",
            "license": "APRN.CNP.003409",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OH",
            "license": "APRN.CNP.0034309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Lee Witwer, RPH
• Debra Wright, CDCA
• Xcel Physical Therapy LLC
• Xcel Sports Medicine
• Xcel Sports Medicine LLC
• Kassie Yohey
• Katherine Marie Yost, STNA

• Pediatric Nurse Practitioner in Vandalia, OH
• Providers in Vandalia, OH by specialty
• Pediatric Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.