Provider Demographics
NPI:1720586621
Name:YULE, TRACE ROBERT (CNP)
Entity Type:Individual
Prefix:
First Name:TRACE
Middle Name:ROBERT
Last Name:YULE
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1010 CARONDELET DR STE 220
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4822
Mailing Address - Country:US
Mailing Address - Phone:816-523-0103
Mailing Address - Fax:816-361-6471
Practice Address - Street 1:1010 CARONDELET DR STE 220
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4822
Practice Address - Country:US
Practice Address - Phone:816-523-0103
Practice Address - Fax:816-361-6471
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018001607363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health