MEDICARE: CAROLINE S. N. YOUNG PA-C, MMSC

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	363A00000X	Physician Assistant	004022	GA
2	363A00000X	Physician Assistant	PA.0005224	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720171267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE S. N. YOUNG PA-C, MMSC

Provider Business Mailing Address
First Line	:	2121 E HARMONY RD UNIT 170
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3413
Country	:	US
Telephone Number	:	970-493-6337
Fax Number	:	970-493-3528

Provider Business Practice Location Address
First Line	:	2121 E HARMONY RD UNIT 170
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3413
Country	:	US
Telephone Number	:	970-493-6337
Fax Number	:	970-493-3528

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/08/2018

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