Healthcare Provider Details

I. General information

NPI: 1801906987
Provider Name (Legal Business Name): PATRICE DANITA YOUNG MSN, PMHCNS, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATTIE YOUNG

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 E MAIN ST
RICHMOND IN
47374-5707
US

IV. Provider business mailing address

1901 E MAIN ST
RICHMOND IN
47374-5707
US

V. Phone/Fax

Practice location:
  • Phone: 765-935-7284
  • Fax: 765-935-5002
Mailing address:
  • Phone: 765-935-7284
  • Fax: 765-935-5002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number70000093A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: