Provider Demographics
NPI:1023062007
Name:YATES, KELLY ANNE (PT, MSPT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:YATES
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANNE
Other - Last Name:LIPSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MSPT
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:225 N MOONLIGHT RD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-1928
Practice Address - Country:US
Practice Address - Phone:913-856-7927
Practice Address - Fax:913-856-8442
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2868002OtherMEDICARE PTAN
35005042OtherBCBS KC