Provider Demographics
NPI:1033347570
Name:YATES, JEFFREY GERALD (MPA, PA-C)
Entity Type:Individual
Prefix:PROF
First Name:JEFFREY
Middle Name:GERALD
Last Name:YATES
Suffix:
Gender:M
Credentials:MPA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8960
Mailing Address - Fax:757-446-5197
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8960
Practice Address - Fax:757-446-5197
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001689363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1033347570Medicaid
VA10102569POtherOPTIMA HEALTH
VAPAROtherCORVEL
VA-019OtherTRICARE/CHAMPUS
NC8103007Medicaid
VAPAROtherUSA MANAGED CARE
VAPAROtherMULTIPLAN
VAPAROtherCORVEL
NC8103007Medicaid