Healthcare Provider Details

I. General information

NPI: 1336683424
Provider Name (Legal Business Name): KRISTEN JEAN-MARIE YOUNGER RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 CREEK RD
ERWIN TN
37650-3043
US

IV. Provider business mailing address

191 CREEK RD
ERWIN TN
37650-3043
US

V. Phone/Fax

Practice location:
  • Phone: 423-388-5310
  • Fax:
Mailing address:
  • Phone: 423-388-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License NumberRRT0000006678
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: