Active NPI
Kim A Yeakel, PNP
- Pediatric Nurse Practitioner
- Phoenix, AZ
National Provider Identifier
1134374754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- AP2112
- Practice address
- 2120 N Central Ave
Phoenix, AZ 85004-1455 - Phone
- (602) 933-6100
- Fax
- (602) 933-2422
- NPI assigned
- Nov 24, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | AP2112 | AZ | Primary |
Addresses
Primary practice location
2120 N Central Ave
Phoenix, AZ 85004-1455
Mailing address
3200 E Camelback Rd
Ste 250
Phoenix, AZ 85018-2327
Phone (602) 933-1814
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 412012 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP2112 | AZ | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alaska Native Tribal Health Consortium | Current | Accepting new patients |
Locations
4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729
4000 Ambassador Dr
Anchorage, AK 99508
Phone (907) 729-1900
Interoperability endpoints
- kayeakel@direct.anthc.org
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623888000000",
"number": "1134374754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 E CAMELBACK RD",
"address_2": "STE 250",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850182327",
"telephone_number": "602-933-1814",
"fax_number": "602-933-1820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2120 N CENTRAL AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850041455",
"telephone_number": "602-933-6100",
"fax_number": "602-933-2422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YEAKEL",
"first_name": "KIM",
"middle_name": "A",
"credential": "PNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-24",
"last_updated": "2021-06-17",
"certification_date": "2021-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "AZ",
"license": "AP2112",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "412012",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.