Healthcare Provider Details

I. General information

NPI: 1265951917
Provider Name (Legal Business Name): KAYLA YATES PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 S LINDELL ST
MARTIN TN
38237-2442
US

IV. Provider business mailing address

2956 N COUNTY HOME RD
UNION CITY TN
38261-8022
US

V. Phone/Fax

Practice location:
  • Phone: 731-281-4292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23160
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: