Healthcare Provider Details

I. General information

NPI: 1629538772
Provider Name (Legal Business Name): KATHERINE JERNIGAN YOUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653-1 W 8TH ST # L17
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

653-1 W 8TH ST # L17
JACKSONVILLE FL
32209-6511
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1037
  • Fax: 904-244-4059
Mailing address:
  • Phone: 904-383-1037
  • Fax: 904-244-4059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN29214
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberTRN29214
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: