=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790491355
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AGA DANEEN YOUNG WELLNESSPRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2023
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 606 N UTICA ST
-----------------------------------------------------
City | TERRY
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39170-8837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 769-245-7938
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3072 LITTLE ROCK RD
-----------------------------------------------------
City | CRYSTAL SPRINGS
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39059-9558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0901X
-----------------------------------------------------
Taxonomy Name | Public Health & General Preventive Medicine Physician
-----------------------------------------------------
License Number | 3322-4030
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number | 3322-4030
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number | 3322-4030
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------