Healthcare Provider Details

I. General information

NPI: 1679197875
Provider Name (Legal Business Name): DAVID LEE YOUNG DNP/FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 W TRUCKERS DR
FAYETTEVILLE AR
72704-5637
US

IV. Provider business mailing address

346 SOUTHWINDS RD
FARMINGTON AR
72730-8648
US

V. Phone/Fax

Practice location:
  • Phone: 479-973-6000
  • Fax:
Mailing address:
  • Phone: 501-463-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberXXX
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: