Healthcare Provider Details

I. General information

NPI: 1992110043
Provider Name (Legal Business Name): NICOLE PATRICK YOUNG CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 MOBILE INFIRMARY BLVD
MOBILE AL
36607-3510
US

IV. Provider business mailing address

1855 SPRING HILL AVE
MOBILE AL
36607-2301
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-1895
  • Fax: 251-433-1917
Mailing address:
  • Phone: 251-471-3544
  • Fax: 251-476-7456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-115256
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: