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General NPI Number Information
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NPI Number | 1184590556
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Entity Type | Individual
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Provider Name | DEAN KELLY YOUNG
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Gender | Male
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Dates
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Enumeration Date | 10/14/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 1601 E FOURTH PLAIN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98661-3713
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Country | US
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Telephone | 360-759-1901
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Fax | 360-759-1685
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Provider Business Mailing Address
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Address Line | 1609 24TH AVE
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City | LONGVIEW
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State | WA
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Zip | 98632-3623
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Country | US
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Telephone | 360-759-1901
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Fax | 360-759-1685
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN60347890
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License Number State | WA
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