Healthcare Provider Details

I. General information

NPI: 1952658403
Provider Name (Legal Business Name): JIM BRIAN YOUNG APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 FORT LOUDOUN MEDICAL CENTER DR STE 203
LENOIR CITY TN
37772-5676
US

IV. Provider business mailing address

900 E HILL AVE SUITE 230
KNOXVILLE TN
37915-2566
US

V. Phone/Fax

Practice location:
  • Phone: 865-271-6095
  • Fax: 865-271-6096
Mailing address:
  • Phone: 865-862-3563
  • Fax: 865-544-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN16874
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: