Healthcare Provider Details

I. General information

NPI: 1275088437
Provider Name (Legal Business Name): SACHA DEGRAFFENREID-YATES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 S MAIN ST STE 202
JOPLIN MO
64801-4540
US

IV. Provider business mailing address

1027 S MAIN ST STE 202
JOPLIN MO
64801-4540
US

V. Phone/Fax

Practice location:
  • Phone: 417-624-0050
  • Fax: 417-624-1331
Mailing address:
  • Phone: 417-624-0050
  • Fax: 417-624-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77341
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: