Provider Demographics
NPI:1538590591
Name:YATES, REBEKAH (PA)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:YATES
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 1:148 N SMALLWOOD PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-5236
Mailing Address - Country:US
Mailing Address - Phone:704-756-2649
Mailing Address - Fax:
Practice Address - Street 1:9820 NORTHCROSS CENTER CT STE 53
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7357
Practice Address - Country:US
Practice Address - Phone:704-756-2649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-10581363A00000X
SC1979363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant