Healthcare Provider Details

I. General information

NPI: 1164668349
Provider Name (Legal Business Name): KATHRYN M YOUNG ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 KENTON STATION DR
MAYSVILLE KY
41056-9609
US

IV. Provider business mailing address

PO BOX 550
VANCEBURG KY
41179-0550
US

V. Phone/Fax

Practice location:
  • Phone: 606-759-5331
  • Fax: 606-759-5363
Mailing address:
  • Phone: 606-796-3029
  • Fax: 606-796-6221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3005835
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: