Provider Demographics
NPI:1326432840
Name:YATES, MANDY
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8501
Mailing Address - Country:US
Mailing Address - Phone:913-588-1300
Mailing Address - Fax:913-588-1300
Practice Address - Street 1:4000 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8501
Practice Address - Country:US
Practice Address - Phone:913-588-1300
Practice Address - Fax:913-588-1300
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2018-05-07
Deactivation Date:2018-03-19
Deactivation Code:
Reactivation Date:2018-05-04
Provider Licenses
StateLicense IDTaxonomies
KS118055163W00000X
KS2017036442363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse