Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 22501 | SC |
N | 363LG0600X | Nurse Practitioner - Gerontology | 22501 | SC |
NPI | 1083187942 |
---|---|
Provider Name | Kaila Anne Young |
First Address | West Columbia, SC 29171-6069 |
Second Address | West Columbia, SC 29169-4810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2019 |
Last Update Date | 11/11/2020 |