Provider Demographics
NPI:1609197060
Name:YEATS, MELISSA LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNNE
Last Name:YEATS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5306
Mailing Address - Country:US
Mailing Address - Phone:913-782-8487
Mailing Address - Fax:913-782-4634
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5306
Practice Address - Country:US
Practice Address - Phone:913-782-8487
Practice Address - Fax:913-782-4634
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-35339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201076960AMedicaid
KS033D00093Medicare PIN