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General NPI Number Information
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NPI Number | 1457785123
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Entity Type | Individual
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Provider Name | REBECCA VANESSA YOUNG FNP
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Gender | Female
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 109 E 5TH ST
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City | CARUTHERSVILLE
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State | MO
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Zip | 63830-1417
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Country | US
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Telephone | 573-359-9803
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Fax | 573-359-0990
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Provider Business Mailing Address
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Address Line | 6738 STATE HIGHWAY 77
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City | BENTON
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State | MO
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Zip | 63736-8238
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Country | US
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Telephone | 573-313-2500
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Fax | 573-313-2505
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2005027734
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2013013681
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License Number State | MO
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