Individual
KEVIN YEATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
301 FISHER ST, KEESLER AFB, MS 39534-2508
(228) 376-0385
Mailing address
301 FISHER ST, KEESLER AFB, MS 39534-2508
(228) 376-0385
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY60883706
WA
103T00000X
Psychologist
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/28/2016
Last updated
08/20/2024
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