=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528400918
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA ANN T YOUNG FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2013
-----------------------------------------------------
Last Update Date | 10/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9407 CUMBERLAND RD STE A
-----------------------------------------------------
City | NEW KENT
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23124-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-996-2242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9407 CUMBERLAND RD STE A
-----------------------------------------------------
City | NEW KENT
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23124-2029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-996-2242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 0024171360
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 0024173140
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------