Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 218740 | LA |
NPI | 1063184083 |
---|---|
Provider Name | Kayla Deann Young |
First Address | Addis, LA 70710-3025 |
Second Address | Baton Rouge, LA 70806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2021 |
Last Update Date | 28/09/2021 |