Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | BP10047965 | TX |
Y | 207Q00000X | Family Doctor | Q2964 | TX |
NPI | 1003255399 |
---|---|
Provider Name | Rachelle Young |
First Address | Fort Stockton, TX 79735-2700 |
Second Address | Fort Stockton, TX 79735-2700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 08/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
347323303 | (05) | TX |