Healthcare Provider Details

I. General information

NPI: 1427573336
Provider Name (Legal Business Name): KIMBERLY ANN YATES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26351 PATRIOTS WAY
GEORGETOWN DE
19947-2575
US

IV. Provider business mailing address

224 COUNTRY FIELD DR
CAMDEN WYOMING DE
19934-1774
US

V. Phone/Fax

Practice location:
  • Phone: 302-933-3000
  • Fax:
Mailing address:
  • Phone: 302-423-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0020966
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0001064
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0001064
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: