Healthcare Provider Details

I. General information

NPI: 1669301990
Provider Name (Legal Business Name): ALEXIS JULIA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9039 MEADOWS RD
TABERG NY
13471-2829
US

IV. Provider business mailing address

9039 MEADOWS RD
TABERG NY
13471-2829
US

V. Phone/Fax

Practice location:
  • Phone: 315-941-0434
  • Fax:
Mailing address:
  • Phone: 315-941-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number702319
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: