Provider Demographics
NPI:1477789873
Name:PRATT, YONG (DO)
Entity Type:Individual
Prefix:
First Name:YONG
Middle Name:
Last Name:PRATT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-3128
Mailing Address - Country:US
Mailing Address - Phone:712-328-5490
Mailing Address - Fax:712-325-2499
Practice Address - Street 1:7261 MERCY RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2311
Practice Address - Country:US
Practice Address - Phone:712-328-5490
Practice Address - Fax:712-325-2499
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE906207R00000X, 208M00000X
IA04335207R00000X
IADO-04335208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA414530125OtherMEDICARE PTAN
NE098684527OtherMEDICARE PTAN