Provider Demographics
NPI:1477442812
Name:YATES, DALTON DWAYNE
Entity type:Individual
Prefix:
First Name:DALTON
Middle Name:DWAYNE
Last Name:YATES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 DIX FRK
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:KY
Mailing Address - Zip Code:41564-8836
Mailing Address - Country:US
Mailing Address - Phone:606-625-8649
Mailing Address - Fax:
Practice Address - Street 1:3304 DIX FRK
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:KY
Practice Address - Zip Code:41564-8836
Practice Address - Country:US
Practice Address - Phone:606-625-8649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program