Provider Demographics
NPI:1679652663
Name:YATES, RUTH A (MS APRN PMH)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:A
Last Name:YATES
Suffix:
Gender:F
Credentials:MS APRN PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-0055
Mailing Address - Country:US
Mailing Address - Phone:410-825-1567
Mailing Address - Fax:410-825-1567
Practice Address - Street 1:515 PICCADILLY ROAD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-3716
Practice Address - Country:US
Practice Address - Phone:410-825-1567
Practice Address - Fax:410-825-1567
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR063670364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
S81958Medicare UPIN
075RMedicare ID - Type Unspecified