Provider Demographics
NPI:1649595117
Name:YEKAITIS, KEVIN FRANCIS (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:FRANCIS
Last Name:YEKAITIS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
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Mailing Address - Street 1:206 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3115
Mailing Address - Country:US
Mailing Address - Phone:662-534-2227
Mailing Address - Fax:662-534-2330
Practice Address - Street 1:3964 GOODMAN RD E
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-8761
Practice Address - Country:US
Practice Address - Phone:662-420-7350
Practice Address - Fax:662-874-5214
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR863320363LF0000X
TNAPN0000014853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10350I4093Medicare UPIN
MS302I503998Medicare UPIN