Healthcare Provider Details

I. General information

NPI: 1649198722
Provider Name (Legal Business Name): ILAH ELIZABETH YATES FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 N MOUNT AUBURN RD STE A
CAPE GIRARDEAU MO
63701-2171
US

IV. Provider business mailing address

2540 KENNETH DR
CAPE GIRARDEAU MO
63701-8482
US

V. Phone/Fax

Practice location:
  • Phone: 573-803-2941
  • Fax:
Mailing address:
  • Phone: 573-225-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2022046092
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: