Healthcare Provider Details

I. General information

NPI: 1225733876
Provider Name (Legal Business Name): AIMEE YEATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 SUGAR MAPLE DR
WRIGHT PATTERSON AFB OH
45433-5529
US

IV. Provider business mailing address

2633 SAFFRON LN APT 36
BEAVERCREEK OH
45431-2377
US

V. Phone/Fax

Practice location:
  • Phone: 937-522-4784
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-19466
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: