Healthcare Provider Details

I. General information

NPI: 1699159848
Provider Name (Legal Business Name): SCOTLYN YEATES PMHNP-BC, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SCOTLYN SULLIVAN FNP-BC

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 WORCESTER ST
WEST BOYLSTON MA
01583-1751
US

IV. Provider business mailing address

148 WORCESTER ST
WEST BOYLSTON MA
01583-1751
US

V. Phone/Fax

Practice location:
  • Phone: 508-835-1735
  • Fax:
Mailing address:
  • Phone: 508-835-1735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2270367
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2270367
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: