Healthcare Provider Details

I. General information

NPI: 1194109009
Provider Name (Legal Business Name): CHELSEA LEIGH YOUNG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 E BROAD ST
SAINT PAULS NC
28384-1612
US

IV. Provider business mailing address

PO BOX 647
HOPE MILLS NC
28348-0647
US

V. Phone/Fax

Practice location:
  • Phone: 910-241-3136
  • Fax: 910-241-3159
Mailing address:
  • Phone: 910-483-7337
  • Fax: 910-483-0648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001005881
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: