MEDICARE: JAMES YOUNT PA

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	363A00000X	Physician Assistant	50000961	OH
2	363A00000X	Physician Assistant	PA771	KY

General Provider Information

NPI Number	:	1730122680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES YOUNT PA

Provider Business Mailing Address
First Line	:	PO BOX 550
Second Line	:
City	:	VANCEBURG
State	:	KY
Zip	:	41179-0550
Country	:	US
Telephone Number	:	606-796-3029
Fax Number	:	606-796-6221

Provider Business Practice Location Address
First Line	:	142 DEPOT DRIVE
Second Line	:
City	:	SOUTH SHORE
State	:	KY
Zip	:	41175
Country	:	US
Telephone Number	:	606-932-2271
Fax Number	:	606-932-2273

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	03/22/2012

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Directions to “ JAMES YOUNT PA” Practice Location

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