Provider Demographics
NPI:1689093650
Name:ANDERSON, YVETTE LEE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:YVETTE
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:YVETTE
Other - Middle Name:LEE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:YVETTER LEE REYNOLDS
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:972-715-9976
Practice Address - Street 1:6606 LBJ FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR078511163W00000X
TXAP125514367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX345691501Medicaid
TXP01473666OtherRR
TX8248UKOtherBCBS
TX8248UKOtherBCBS