Healthcare Provider Details

I. General information

NPI: 1669318382
Provider Name (Legal Business Name): HOLLY REGINA YOUNG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 N MAIN ST
SUMTER SC
29153-8691
US

IV. Provider business mailing address

2150 N MAIN ST
SUMTER SC
29153-8691
US

V. Phone/Fax

Practice location:
  • Phone: 803-469-8712
  • Fax:
Mailing address:
  • Phone: 803-469-8712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number238709
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: