MEDICARE: MRS. KATHLEEN YOUNG HARRELL ARNP

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	363LA2200X	Adult Health Nurse Practitioner	2826532	FL
2	363L00000X	Nurse Practitioner	2826532	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043295090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN YOUNG HARRELL ARNP

Provider Business Mailing Address
First Line	:	17121 RAINBOW TERRACE
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556
Country	:	US
Telephone Number	:	813-749-6907
Fax Number	:	813-475-4831

Provider Business Practice Location Address
First Line	:	17121 RAINBOW TERRACE
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556
Country	:	US
Telephone Number	:	813-749-6707
Fax Number	:	813-475-4831

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/22/2014

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