Provider Demographics
NPI:1104018969
Name:YATES, PATRICIA KPAN (RN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:KPAN
Last Name:YATES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5026 ACORN FOREST LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1732
Mailing Address - Country:US
Mailing Address - Phone:704-599-0662
Mailing Address - Fax:
Practice Address - Street 1:5026 ACORN FOREST LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1732
Practice Address - Country:US
Practice Address - Phone:704-599-0662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202489163W00000X, 374U00000X
NC5011578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5011578OtherAANP