Provider Demographics
NPI:1679784128
Name:YATES, LINDA KAY (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KAY
Last Name:YATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088
Mailing Address - Country:US
Mailing Address - Phone:901-754-7855
Mailing Address - Fax:901-754-7855
Practice Address - Street 1:1401 DEXTER LANE
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016
Practice Address - Country:US
Practice Address - Phone:901-754-7855
Practice Address - Fax:901-754-7855
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD8485207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B03611Medicare UPIN