Healthcare Provider Details

I. General information

NPI: 1003677899
Provider Name (Legal Business Name): JORDAN TAYLOR YOUNG PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MADISON AVE RM 2000
NEW YORK NY
10017-5416
US

IV. Provider business mailing address

PO BOX 353
HOMER NY
13077-0353
US

V. Phone/Fax

Practice location:
  • Phone: 929-667-7271
  • Fax: 929-671-3068
Mailing address:
  • Phone: 607-345-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF405880
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number798974
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: