MEDICARE: HOLLY ROCHELLE YOUNG-REESE NP

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	363L00000X	Nurse Practitioner	28132047A	IN
2	363L00000X	Nurse Practitioner	71004525A	IN
3	363LF0000X	Family Nurse Practitioner	71004525A	IN

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	:	1194164863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY ROCHELLE YOUNG-REESE NP

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9821 LIMA RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-9280
Country	:	US
Telephone Number	:	260-240-5027
Fax Number	:	260-209-5119

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

Provider Enumeration Date	:	06/17/2013
Last Update Date	:	01/14/2025

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