Healthcare Provider Details

I. General information

NPI: 1063999852
Provider Name (Legal Business Name): LINDSAY YOUNG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 12/30/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42121 US HIGHWAY 70
PORTALES NM
88130-9054
US

IV. Provider business mailing address

1600 EUREKA RD
ROSEVILLE CA
95661-3027
US

V. Phone/Fax

Practice location:
  • Phone: 575-356-6652
  • Fax: 575-359-6827
Mailing address:
  • Phone: 575-356-6652
  • Fax: 575-359-6827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53355
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: