MEDICARE: SACHA DEGRAFFENREID-YATES APRN

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	363LF0000X	Family Nurse Practitioner	77341	KS

General Provider Information

NPI Number	:	1275088437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SACHA DEGRAFFENREID-YATES APRN

Provider Business Mailing Address
First Line	:	1027 S MAIN ST STE 202
Second Line	:
City	:	JOPLIN
State	:	MO
Zip	:	64801-4540
Country	:	US
Telephone Number	:	417-624-0050
Fax Number	:	417-624-1331

Provider Business Practice Location Address
First Line	:	1027 S MAIN ST STE 202
Second Line	:
City	:	JOPLIN
State	:	MO
Zip	:	64801-4540
Country	:	US
Telephone Number	:	417-624-0050
Fax Number	:	417-624-1331

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

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	12/18/2025

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