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General NPI Number Information
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NPI Number | 1083804322
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Entity Type | Individual
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Provider Name | KIMBERLY A YEATES O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 1913 HIGHWAY 45 N
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City | COLUMBUS
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State | MS
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Zip | 39705-1950
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Country | US
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Telephone | 601-917-0667
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Fax |
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Provider Business Mailing Address
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Address Line | 834 HIGHWAY 12 W # 109
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City | STARKVILLE
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State | MS
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Zip | 39759-3582
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Country | US
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Telephone | 601-917-0667
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 782
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License Number State | MS
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