Provider Demographics
NPI:1962289207
Name:YATES, ALEXANDRA (CRNP)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:YATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:400 E MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:529 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARKESBURG
Practice Address - State:PA
Practice Address - Zip Code:19365-1019
Practice Address - Country:US
Practice Address - Phone:714-766-9957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN763796163WE0003X
PASP029521363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency