Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 150809 | TN |
NPI | 1013218866 |
---|---|
Provider Name | Laura June Young |
First Address | Mcminnville, TN 37110-2134 |
Second Address | Cookeville, TN 38501-0901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2010 |
Last Update Date | 20/10/2011 |