=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073157582
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HALEY YOUNG PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2019
-----------------------------------------------------
Last Update Date | 01/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 838 COLUMBIA CIR
-----------------------------------------------------
City | NORTH AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60542-1812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-448-0545
-----------------------------------------------------
Fax | 630-326-8652
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 838 COLUMBIA CIR
-----------------------------------------------------
City | NORTH AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60542-1812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-330-3659
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 085.007329
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------