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General NPI Number Information
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NPI Number | 1023503554
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Entity Type | Individual
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Provider Name | GRENISHA L YOUNG APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 2941 TERRY RD STE 6
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City | JACKSON
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State | MS
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Zip | 39212-3071
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Country | US
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Telephone | 601-363-0566
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Fax |
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Provider Business Mailing Address
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Address Line | 322 GREENSBORO DR
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City | BRANDON
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State | MS
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Zip | 39047-4700
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Country | US
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Telephone | 601-334-0113
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 902641
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License Number State | MS
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