Healthcare Provider Details

I. General information

NPI: 1053727784
Provider Name (Legal Business Name): LINDSEY YOUNGBLOOD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5231 JOHN TYLER HWY
WILLIAMSBURG VA
23185
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD STE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-220-8300
  • Fax: 757-565-5338
Mailing address:
  • Phone: 757-316-5800
  • Fax: 757-534-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024171774
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: