Provider Demographics
NPI:1619369105
Name:YATES, LIONEL (CNA)
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:
Last Name:YATES
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FOXHALL DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-8184
Mailing Address - Country:US
Mailing Address - Phone:843-909-4713
Mailing Address - Fax:
Practice Address - Street 1:200 FOXHALL DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-8184
Practice Address - Country:US
Practice Address - Phone:843-909-4713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 372600000X, 3747A0650X, 3747P1801X, 374T00000X, 374U00000X, 376J00000X, 376K00000X
SC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker