Healthcare Provider Details

I. General information

NPI: 1619933926
Provider Name (Legal Business Name): ALTON YOUNG CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 W PIERCE ST
CARLSBAD NM
88220-3553
US

IV. Provider business mailing address

1814 RINCON ST
CARLSBAD NM
88220-3936
US

V. Phone/Fax

Practice location:
  • Phone: 575-887-4100
  • Fax:
Mailing address:
  • Phone: 256-682-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR55383
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: