MEDICARE: KRISTINE L YOUNG PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA10005064	WA
2	363A00000X	Physician Assistant	0110004268	VA

General Provider Information

NPI Number	:	1033109772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE L YOUNG PA-C

Provider Business Mailing Address
First Line	:	275 SE CABOT DR
Second Line	:	SUITE B101
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-3715
Country	:	US
Telephone Number	:	360-675-6648
Fax Number	:	360-679-2487

Provider Business Practice Location Address
First Line	:	275 SE CABOT DR
Second Line	:	SUITE B101
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-3715
Country	:	US
Telephone Number	:	360-675-6648
Fax Number	:	360-679-2487

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	04/09/2014

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