Provider Demographics
NPI:1770273880
Name:YATES, TARINA RAECHEL (BAS, CD(DONA))
Entity type:Individual
Prefix:
First Name:TARINA
Middle Name:RAECHEL
Last Name:YATES
Suffix:
Gender:F
Credentials:BAS, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CALIFORNIA ST
Mailing Address - Street 2:PO BOX 577
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918
Mailing Address - Country:US
Mailing Address - Phone:618-519-9200
Mailing Address - Fax:618-985-4635
Practice Address - Street 1:101 S WALL ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3021
Practice Address - Country:US
Practice Address - Phone:618-519-9200
Practice Address - Fax:618-519-9404
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN