Healthcare Provider Details

I. General information

NPI: 1346645207
Provider Name (Legal Business Name): TABITHA MICHELLE VOSHELL YOUNG R.N., I.B.C.L.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 RANSON ST
INDEPENDENCE MO
64057-2717
US

IV. Provider business mailing address

1311 RANSON ST
INDEPENDENCE MO
64057-2717
US

V. Phone/Fax

Practice location:
  • Phone: 816-787-7144
  • Fax:
Mailing address:
  • Phone: 816-787-7144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-56392
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: