Provider Demographics
NPI:1851194815
Name:YATES, KATELYN ELAINE (PA)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ELAINE
Last Name:YATES
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 CENTER STREET EXT APT 804
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4652
Mailing Address - Country:US
Mailing Address - Phone:757-371-5458
Mailing Address - Fax:
Practice Address - Street 1:111 LOVETT DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6510
Practice Address - Country:US
Practice Address - Phone:801-869-4100
Practice Address - Fax:208-869-4119
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5805363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical