Healthcare Provider Details

I. General information

NPI: 1134035504
Provider Name (Legal Business Name): DAMON YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3598 ANTHONY FERRY RD
SULPHUR LA
70663-0055
US

IV. Provider business mailing address

3598 ANTHONY FERRY RD
SULPHUR LA
70663-0055
US

V. Phone/Fax

Practice location:
  • Phone: 337-842-6972
  • Fax:
Mailing address:
  • Phone: 337-842-6972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1569
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: