Healthcare Provider Details

I. General information

NPI: 1033055710
Provider Name (Legal Business Name): HUNTER ELIJAH YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 E KELSO RD
COLUMBUS OH
43202-2309
US

IV. Provider business mailing address

31 E KELSO RD
COLUMBUS OH
43202-2309
US

V. Phone/Fax

Practice location:
  • Phone: 937-657-4456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.494821
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: