Healthcare Provider Details

I. General information

NPI: 1740317510
Provider Name (Legal Business Name): TAMARA K YOUNG CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA YEKYAR

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 2009B
SAINT LOUIS MO
63141-8265
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6092
  • Fax:
Mailing address:
  • Phone: 314-251-7498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209028382
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209028382
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209028382
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2018032033
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: