Healthcare Provider Details

I. General information

NPI: 1558165548
Provider Name (Legal Business Name): KALEIGH REBECA YOUNGER CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 HOSPITAL ST STE 104
PASCAGOULA MS
39581-5312
US

IV. Provider business mailing address

4105 HOSPITAL ST STE 104
PASCAGOULA MS
39581-5312
US

V. Phone/Fax

Practice location:
  • Phone: 228-762-9595
  • Fax:
Mailing address:
  • Phone: 228-762-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number907349
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: