Healthcare Provider Details

I. General information

NPI: 1487184446
Provider Name (Legal Business Name): BRYCE DAVID YATES PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/04/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W SPRINGDALE AVE
KNOXVILLE TN
37917-5158
US

IV. Provider business mailing address

200 TECH CENTER DR
KNOXVILLE TN
37912-2747
US

V. Phone/Fax

Practice location:
  • Phone: 865-637-9711
  • Fax:
Mailing address:
  • Phone: 865-637-9711
  • Fax: 704-480-1832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number35757
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: