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NPI Code Detail

MEDICARE: HOLLY YEATTS NP

MEDICARE: HOLLY YEATTS NP
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
1363LA2100XAcute Care Nurse PractitionerNP07594OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326073446
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY YEATTS NP
Provider Business Mailing Address
First Line : 500 KIRTS BLVD STE 100
Second Line :
City : TROY
State : MI
Zip : 48084-4135
Country : US
Telephone Number : 248-434-6169
Fax Number : 855-618-6655
Provider Business Practice Location Address
First Line : 2132 E 3RD ST
Second Line :
City : DAYTON
State : OH
Zip : 45403-1991
Country : US
Telephone Number : 937-528-6850
Fax Number : 937-528-6810
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 10/06/2021

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