Provider Demographics
NPI:1497205355
Name:YATES, TRISTAN JADE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:JADE
Last Name:YATES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TRISTAN
Other - Middle Name:JADE
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:364 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228-6786
Mailing Address - Country:US
Mailing Address - Phone:276-926-0200
Mailing Address - Fax:276-926-6675
Practice Address - Street 1:364 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228-6786
Practice Address - Country:US
Practice Address - Phone:276-926-0200
Practice Address - Fax:276-926-6675
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily