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General NPI Number Information
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NPI Number | 1508224775
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Entity Type | Individual
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Provider Name | JORDAN WEBB YOUNG PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 100 KNOTBREAK RD
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City | SALEM
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State | VA
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Zip | 24153-5414
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Country | US
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Telephone | 540-444-5670
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Fax |
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Provider Business Mailing Address
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Address Line | 2041 NORTHSHIRE DR
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City | TUPELO
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State | MS
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Zip | 38804-7020
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110-005899
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License Number State | VA
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