Provider Demographics
NPI:1366934069
Name:YATES, KELSI BROOKE (NP)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:BROOKE
Last Name:YATES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 S FREMONT AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2258
Mailing Address - Country:US
Mailing Address - Phone:417-820-7250
Mailing Address - Fax:
Practice Address - Street 1:1965 S FREMONT AVE STE 230
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2258
Practice Address - Country:US
Practice Address - Phone:417-820-7250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010025709163W00000X
MO2018024047363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse