Healthcare Provider Details

I. General information

NPI: 1780577536
Provider Name (Legal Business Name): KATELYN YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 VILLA LINDE PKWY STE A
FLINT MI
48532-3445
US

IV. Provider business mailing address

5040 VILLA LINDE PKWY STE A
FLINT MI
48532-3445
US

V. Phone/Fax

Practice location:
  • Phone: 810-399-9931
  • Fax: 810-382-2022
Mailing address:
  • Phone: 810-399-9931
  • Fax: 810-382-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: