=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184045957
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDY STROUP YOUNG DNP, APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2013
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1722 PINE ST
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36106-1103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-391-7728
-----------------------------------------------------
Fax | 334-834-8347
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 791 OLD RIDGE RD N
-----------------------------------------------------
City | PRATTVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36066-1951
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-391-7728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 1-105210
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F0612235
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------