Provider Demographics
NPI:1952611683
Name:YATES ANESTHESIA, PA
Entity Type:Organization
Organization Name:YATES ANESTHESIA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:BULKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, MS
Authorized Official - Phone:870-476-0850
Mailing Address - Street 1:107 CYPRESS POINTE
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450
Mailing Address - Country:US
Mailing Address - Phone:870-476-0850
Mailing Address - Fax:870-240-8028
Practice Address - Street 1:107 CYPRESS POINTE
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450
Practice Address - Country:US
Practice Address - Phone:870-476-0850
Practice Address - Fax:870-240-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC02659367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty