Healthcare Provider Details

I. General information

NPI: 1184590556
Provider Name (Legal Business Name): DEAN KELLY YOUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E FOURTH PLAIN BLVD
VANCOUVER WA
98661-3713
US

IV. Provider business mailing address

1609 24TH AVE
LONGVIEW WA
98632-3623
US

V. Phone/Fax

Practice location:
  • Phone: 360-759-1901
  • Fax: 360-759-1685
Mailing address:
  • Phone: 360-759-1901
  • Fax: 360-759-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN60347890
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: