Provider Demographics
NPI:1891791059
Name:YATES, KAREN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:YATES
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 1:1413 N MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-2171
Mailing Address - Country:US
Mailing Address - Phone:573-335-5120
Mailing Address - Fax:573-335-5119
Practice Address - Street 1:1413 N MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2171
Practice Address - Country:US
Practice Address - Phone:573-335-5120
Practice Address - Fax:573-335-5119
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6C64174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO8134OtherBCBS MO PROVIDER #
MO113620OtherHEALTHLINK MO PROVIDER #
MS202112819Medicaid
MO8134OtherBCBS MO PROVIDER #
MO2096Medicare ID - Type UnspecifiedMEDICARE PRIVIDER #