Provider Demographics
NPI:1063811107
Name:YATES, LISA KAY
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:KAY
Last Name:YATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:MO
Mailing Address - Zip Code:65360-1127
Mailing Address - Country:US
Mailing Address - Phone:660-647-9921
Mailing Address - Fax:660-890-8241
Practice Address - Street 1:200 W FLORENCE ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:MO
Practice Address - Zip Code:65360-1127
Practice Address - Country:US
Practice Address - Phone:660-647-9921
Practice Address - Fax:660-890-8241
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044342164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse