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General NPI Number Information
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NPI Number | 1861724874
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Entity Type | Organization
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Legal Business Name | YOUNG CITY MEDICAL CARE
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Dates
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Enumeration Date | 02/02/2010
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Last Update Date | 02/02/2010
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Provider Practice Location Address
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Address Line | 1904 CRUMS LN
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City | LOUISVILLE
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State | KY
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Zip | 40216-4228
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Country | US
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Telephone | 502-644-4068
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Fax |
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Provider Business Mailing Address
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Address Line | 1904 CRUMS LN
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City | LOUISVILLE
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State | KY
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Zip | 40216-4228
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Country | US
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Telephone | 502-644-4068
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JACQUE YOUNG
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Credential | ARNP
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Telephone | 502-644-4068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5867P
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License Number State | KY
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