Healthcare Provider Details

I. General information

NPI: 1336111640
Provider Name (Legal Business Name): BYRON K YOUNG RN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 COUNTRY LANE DR
LUMBERTON TX
77657-6803
US

IV. Provider business mailing address

919 HIDDEN RDG
IRVING TX
75038-3813
US

V. Phone/Fax

Practice location:
  • Phone: 409-755-3010
  • Fax: 409-755-1634
Mailing address:
  • Phone: 469-282-2711
  • Fax: 469-282-2609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number578690
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: