Provider Demographics
NPI:1174523682
Name:YATES, CHRISTY M (APRN)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:M
Last Name:YATES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 SHELBYVILLE RD
Mailing Address - Street 2:SUITE #220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2992
Mailing Address - Country:US
Mailing Address - Phone:502-429-8585
Mailing Address - Fax:502-753-0889
Practice Address - Street 1:9800 SHELBYVILLE RD
Practice Address - Street 2:SUITE #220
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2992
Practice Address - Country:US
Practice Address - Phone:502-429-8585
Practice Address - Fax:502-429-6157
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002509363LF0000X, 363L00000X
IN71001021A363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
500017800OtherRAILROAD MEDICARE
KY1126977OtherPASSPORT PROIVDER NUMBER
000000202844OtherANTHEM
KY78004082Medicaid
IN200314390Medicaid
KYS46870Medicare UPIN
KY78004082Medicaid
500017800OtherRAILROAD MEDICARE
KY0682408Medicare PIN