Healthcare Provider Details

I. General information

NPI: 1407060197
Provider Name (Legal Business Name): CLARA DIANNE YOUNG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCMINN COUNTY HEALTH DEPARTMENT 393 COUNTY ROAD 554
ATHENS TN
37371
US

IV. Provider business mailing address

1085 CHESTUA CHURCH RD
MADISONVILLE TN
37354-7740
US

V. Phone/Fax

Practice location:
  • Phone: 423-745-7431
  • Fax: 423-744-1604
Mailing address:
  • Phone: 423-420-1935
  • Fax: 423-420-1931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0000101202
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: