Healthcare Provider Details

I. General information

NPI: 1225860257
Provider Name (Legal Business Name): KATHERINE YATES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ELM AVE SE
ROANOKE VA
24013-2222
US

IV. Provider business mailing address

17003 GATLIN CT
WOODBRIDGE VA
22191-4446
US

V. Phone/Fax

Practice location:
  • Phone: 540-985-8483
  • Fax:
Mailing address:
  • Phone: 703-576-7896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: