Provider Demographics
NPI:1922767060
Name:YATES, SHAWNA LEA (APN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:LEA
Last Name:YATES
Suffix:
Gender:F
Credentials:APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 S HOLLADAY BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7168
Mailing Address - Country:US
Mailing Address - Phone:801-266-3113
Mailing Address - Fax:
Practice Address - Street 1:2095 N DOLORES RD
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-8924
Practice Address - Country:US
Practice Address - Phone:970-564-8086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997199-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily