MEDICARE: MIKEIA YETT PHMNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	376215	OH
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71012122A	IN

General Provider Information

NPI Number	:	1235506239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKEIA YETT PHMNP

Provider Business Mailing Address
First Line	:	1100 REID PKWY
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1157
Country	:	US
Telephone Number	:	765-983-3084
Fax Number	:	765-983-3219

Provider Business Practice Location Address
First Line	:	3514 FYFFE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-6113
Country	:	US
Telephone Number	:	513-301-6017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2015
Last Update Date	:	02/04/2022

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