Healthcare Provider Details

I. General information

NPI: 1831114958
Provider Name (Legal Business Name): LAINE MICHELLE YOUNG-WALKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAINE YOUNG

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HOSPITAL DR
COLUMBIA MO
65212-0001
US

IV. Provider business mailing address

PO BOX 843966
KANSAS CITY MO
64184-3966
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-1130
  • Fax: 573-884-5936
Mailing address:
  • Phone: 573-884-3300
  • Fax: 573-884-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number114238
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number114238
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: