MEDICARE: REBEKAH YATES P.A.

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	363A00000X	Physician Assistant	0010-10581	NC
2	363A00000X	Physician Assistant	1979	SC

General Provider Information

NPI Number	:	1538590591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH YATES P.A.

Provider Business Mailing Address
First Line	:	148 N SMALLWOOD PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-5236
Country	:	US
Telephone Number	:	704-756-2649
Fax Number	:

Provider Business Practice Location Address
First Line	:	9820 NORTHCROSS CENTER CT STE 53
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7357
Country	:	US
Telephone Number	:	704-756-2649
Fax Number	:

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

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	06/14/2023

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