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General NPI Number Information
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NPI Number | 1053677377
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Entity Type | Organization
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Legal Business Name | YOUNG MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 1302 W COLLIN RAYE DR STE A
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City | DE QUEEN
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State | AR
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Zip | 71832-2588
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Country | US
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Telephone | 870-642-4730
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Fax | 870-381-7273
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Provider Business Mailing Address
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Address Line | 1302 W COLLIN RAYE DR STE A
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City | DE QUEEN
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State | AR
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Zip | 71832-2588
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Country | US
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Telephone | 870-642-4730
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Fax | 870-381-7273
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL YOUNG
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Credential | FNP
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Telephone | 870-642-4730
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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 |
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License Number State |
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