Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 21354 | MS |
N | 2080P0203X | Pediatric Critical Care Doctor | 47865 | WI |
N | 2080P0203X | Pediatric Critical Care Doctor | 53766 | MN |
NPI | 1255345153 |
---|---|
Provider Name | Ms. Kathryn A. Young |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 21/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34624300 | (05) | WI |
I30110 | (02) |