MEDICARE: SHIRLEY JEAN YOUNG PMHNP-BC

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	53-82333-051	KS
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5382333051	KS
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2023031138	MO

General Provider Information

NPI Number	:	1619661857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY JEAN YOUNG PMHNP-BC

Provider Business Mailing Address
First Line	:	2900 CLAY EDWARDS DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-3235
Country	:	US
Telephone Number	:	913-962-0472
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 CLAY EDWARDS DR
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-3235
Country	:	US
Telephone Number	:	816-890-9437
Fax Number	:

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

Provider Enumeration Date	:	06/08/2023
Last Update Date	:	11/09/2023

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