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General NPI Number Information
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NPI Number | 1568123610
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Entity Type | Individual
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Provider Name | AMY ALLISON YEATES
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Gender | Female
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Dates
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Enumeration Date | 12/30/2021
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 2428 N STOKESBERRY PL
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City | MERIDIAN
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State | ID
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Zip | 83646-5035
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Country | US
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Telephone | 208-895-0050
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Fax | 855-543-3086
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Provider Business Mailing Address
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Address Line | 2428 N STOKESBERRY PL
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City | MERIDIAN
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State | ID
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Zip | 83646-5035
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Country | US
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Telephone | 208-895-0050
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Fax | 855-543-3086
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2471259
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2471259
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License Number State | ID
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