Provider Demographics
NPI:1144477449
Name:YEE, MYLENA ANN (PA)
Entity type:Individual
Prefix:
First Name:MYLENA
Middle Name:ANN
Last Name:YEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 RURAL ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3503
Mailing Address - Country:US
Mailing Address - Phone:304-253-2628
Mailing Address - Fax:304-252-1720
Practice Address - Street 1:7031 HARPER RD
Practice Address - Street 2:
Practice Address - City:GLEN DANIEL
Practice Address - State:WV
Practice Address - Zip Code:25844-9480
Practice Address - Country:US
Practice Address - Phone:304-252-8555
Practice Address - Fax:304-934-4005
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3252363A00000X
WV283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3261PAMedicaid