Provider Demographics
NPI:1578942066
Name:YATES, JAMES (APRN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:YATES
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3917
Mailing Address - Country:US
Mailing Address - Phone:573-356-1566
Mailing Address - Fax:
Practice Address - Street 1:8060 COUNTS MASSIE RD
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6657
Practice Address - Country:US
Practice Address - Phone:501-791-0198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004230363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health