Healthcare Provider Details

I. General information

NPI: 1598620098
Provider Name (Legal Business Name): AMANDA NICOLE YATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SAINT CHARLES AVE STE 2500
NEW ORLEANS LA
70170-2500
US

IV. Provider business mailing address

18303 CUSACHS DR
COVINGTON LA
70433-0350
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-9270
  • Fax:
Mailing address:
  • Phone: 877-418-2978
  • Fax: 866-500-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: