Provider Demographics
NPI:1922767060
Name:YATES, SHAWNA LEA (FNP-C)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:LEA
Last Name:YATES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10964 ROAD 26 STE 207
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-8505
Mailing Address - Country:US
Mailing Address - Phone:970-233-2272
Mailing Address - Fax:970-296-5382
Practice Address - Street 1:10964 ROAD 26 STE 207
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-8505
Practice Address - Country:US
Practice Address - Phone:970-233-2272
Practice Address - Fax:970-296-5382
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM78414363LF0000X
COAPN.0997199-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000202016Medicaid
NM18470203Medicaid