Provider Demographics
NPI:1568270635
Name:YELDER, KHAMARIAH PATRICE
Entity type:Individual
Prefix:
First Name:KHAMARIAH
Middle Name:PATRICE
Last Name:YELDER
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 1:1240 W PEACHTREE ST NW APT 1802
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4742
Mailing Address - Country:US
Mailing Address - Phone:907-903-3343
Mailing Address - Fax:
Practice Address - Street 1:1240 W PEACHTREE ST NW APT 1802
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4742
Practice Address - Country:US
Practice Address - Phone:907-903-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN324120163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse