MEDICARE: MRS. BETH A YOUNG MA, RD, CSSD, CD

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	133V00000X	Registered Dietitian	37001559A	IA

General Provider Information

NPI Number	:	1699232678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETH A YOUNG MA, RD, CSSD, CD

Provider Business Mailing Address
First Line	:	8600 UNIVERSITY BLVD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47712-3590
Country	:	US
Telephone Number	:	812-228-5151
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 UNIVERSITY BLVD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47712-3590
Country	:	US
Telephone Number	:	812-228-5151
Fax Number	:

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

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	02/26/2019

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