Healthcare Provider Details

I. General information

NPI: 1013049568
Provider Name (Legal Business Name): YOUNG JOHNATHON LEE YAUGER CRNA, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 04/03/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BROOKE ARMY MEDICAL CENTER 3551 ROGER BROOKE DRIVE
FORT SAM HOUSTON TX
78234
US

IV. Provider business mailing address

118 LUTHER DR
SAN ANTONIO TX
78212-2017
US

V. Phone/Fax

Practice location:
  • Phone: 240-418-2502
  • Fax:
Mailing address:
  • Phone: 240-418-2502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR154690
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberAPRN11017215
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11017215
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: