Healthcare Provider Details

I. General information

NPI: 1225365406
Provider Name (Legal Business Name): THOMAS ISAAC YOUNG FNP-BC, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W ELK AVE
ELIZABETHTON TN
37643-2654
US

IV. Provider business mailing address

1500 W ELK AVE
ELIZABETHTON TN
37643-2654
US

V. Phone/Fax

Practice location:
  • Phone: 423-543-2584
  • Fax: 423-722-2060
Mailing address:
  • Phone: 423-543-2584
  • Fax: 423-722-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024171677
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14443
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: