Provider Demographics
NPI:1669791877
Name:YATES, MARY ALICE (FNP-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ALICE
Last Name:YATES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 HADLEY RD
Mailing Address - Street 2:
Mailing Address - City:HAYSI
Mailing Address - State:VA
Mailing Address - Zip Code:24256-5196
Mailing Address - Country:US
Mailing Address - Phone:276-865-0250
Mailing Address - Fax:
Practice Address - Street 1:553 HADLEY RD
Practice Address - Street 2:
Practice Address - City:HAYSI
Practice Address - State:VA
Practice Address - Zip Code:24256-5196
Practice Address - Country:US
Practice Address - Phone:276-865-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily