1659307379 NPI number — MR. JOSHUA CHARLES YONKER MS, LAT, ATC

Table of content: MR. JOSHUA CHARLES YONKER MS, LAT, ATC (NPI 1659307379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659307379 NPI number — MR. JOSHUA CHARLES YONKER MS, LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YONKER
Provider First Name:
JOSHUA
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, LAT, ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659307379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
06/07/2017

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 RED BIRD LANE
Provider Second Line Business Mailing Address:
CAMPUS BOX 10611
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-880-2359
Provider Business Mailing Address Fax Number:
409-880-2366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 S. MLK JR PKWY
Provider Second Line Business Practice Location Address:
LAMAR UNIV. DAUPHIN ATHLETIC COMPLEX
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-880-2359
Provider Business Practice Location Address Fax Number:
409-880-2366
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  AT3457 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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