Healthcare Provider Details

I. General information

NPI: 1013218866
Provider Name (Legal Business Name): LAURA JUNE YOUNG FAMILY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NEAL ST
COOKEVILLE TN
38501-0901
US

IV. Provider business mailing address

406 N SPRING ST
MCMINNVILLE TN
37110-2134
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-8593
  • Fax:
Mailing address:
  • Phone: 931-507-1212
  • Fax: 931-507-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number150809
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: