Provider Demographics
NPI:1861954919
Name:YATES, CHRISTIN DENAY
Entity type:Individual
Prefix:MISS
First Name:CHRISTIN
Middle Name:DENAY
Last Name:YATES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHRISTIN
Other - Middle Name:DENAY
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18525 W VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-5887
Mailing Address - Country:US
Mailing Address - Phone:623-341-1169
Mailing Address - Fax:
Practice Address - Street 1:435 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2157
Practice Address - Country:US
Practice Address - Phone:623-341-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant