Healthcare Provider Details

I. General information

NPI: 1902257983
Provider Name (Legal Business Name): KATHERINE ANN YOUNG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 OLENTANGY RIVER RD SUITE 1501
COLUMBUS OH
43214-3908
US

IV. Provider business mailing address

103 TABILORE LOOP
DELAWARE OH
43015-9172
US

V. Phone/Fax

Practice location:
  • Phone: 614-788-6100
  • Fax: 614-788-6096
Mailing address:
  • Phone: 614-499-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06161168
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: