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General NPI Number Information
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NPI Number | 1942856562
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Entity Type | Individual
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Provider Name | LAY'C KATHLEEN YOUNG FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 515 N 3RD ST STE A
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City | LONGVIEW
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State | TX
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Zip | 75601-6546
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Country | US
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Telephone | 903-475-2713
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Fax | 903-942-2930
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Provider Business Mailing Address
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Address Line | 3602 TRYON RD
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City | LONGVIEW
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State | TX
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Zip | 75605-8311
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Country | US
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Telephone | 430-200-4350
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Fax | 833-491-2722
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP141594
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License Number State | TX
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