MEDICARE: MRS. LYDIA MOCK YOUNG FNP

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	363LF0000X	Family Nurse Practitioner	4313	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00218784	OTHER	LA	RAILROAD MEDICARE

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	:	1326041849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYDIA MOCK YOUNG FNP

Provider Business Mailing Address
First Line	:	13127 RODDY RD
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737-7316
Country	:	US
Telephone Number	:	225-763-4900
Fax Number	:	225-763-4066

Provider Business Practice Location Address
First Line	:	8595 PICARDY AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-3670
Country	:	US
Telephone Number	:	225-763-4950
Fax Number	:	225-763-4066

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

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	07/09/2009

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