Healthcare Provider Details

I. General information

NPI: 1437994514
Provider Name (Legal Business Name): JAMIE YOUNG DNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 NIKLES DR STE 2A
BOZEMAN MT
59715-2588
US

IV. Provider business mailing address

601 NIKLES DR STE 2A
BOZEMAN MT
59715-2588
US

V. Phone/Fax

Practice location:
  • Phone: 657-780-8389
  • Fax:
Mailing address:
  • Phone: 657-780-8389
  • Fax: 406-551-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNUR-APRN-LIC-265975
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberNUR-RN-LIC-197806
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: