MEDICARE: KATELYN ANN YACKEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	50795	KY
2	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	50795	KY
3	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	50795	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	K000793	OTHER	KY	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184913162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN ANN YACKEY MD

Provider Business Mailing Address
First Line	:	1050 E MARKET ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40206-1874
Country	:	US
Telephone Number	:	502-629-3039
Fax Number	:	502-629-3096

Provider Business Practice Location Address
First Line	:	1050 E MARKET ST
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40206-1874
Country	:	US
Telephone Number	:	502-629-3039
Fax Number	:	502-629-3096

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2011
Last Update Date	:	01/16/2026

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Directions to “ KATELYN ANN YACKEY MD” Practice Location

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