Healthcare Provider Details

I. General information

NPI: 1386669331
Provider Name (Legal Business Name): TAMBRA LYNN YATES CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 E WOODMEN RD STE 405
COLORADO SPRINGS CO
80923-2614
US

IV. Provider business mailing address

PO BOX 800022
KANSAS CITY MO
64180-0022
US

V. Phone/Fax

Practice location:
  • Phone: 719-571-4500
  • Fax: 719-571-4501
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR857462
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberC-APN.0003209-C-CNM
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: