Healthcare Provider Details

I. General information

NPI: 1609197060
Provider Name (Legal Business Name): MELISSA LYNNE YEATS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20375 W 151ST ST SUITE 105
OLATHE KS
66061-5306
US

IV. Provider business mailing address

20375 W 151ST ST SUITE 105
OLATHE KS
66061-5306
US

V. Phone/Fax

Practice location:
  • Phone: 913-782-8487
  • Fax: 913-782-4634
Mailing address:
  • Phone: 913-782-8487
  • Fax: 913-782-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-35339
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: