MEDICARE: MRS. GRENISHA L YOUNG APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	902641	MS
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	902641	MS

General Provider Information

NPI Number	:	1023503554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRENISHA L YOUNG APRN, FNP-C

Provider Business Mailing Address
First Line	:	322 GREENSBORO DR
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-4700
Country	:	US
Telephone Number	:	601-334-0113
Fax Number	:

Provider Business Practice Location Address
First Line	:	2941 TERRY RD STE 6
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-3071
Country	:	US
Telephone Number	:	601-363-0566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	03/20/2026

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