Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 5007169 | NC |
NPI | 1003219429 |
---|---|
Provider Name | Tiffany Young Duckett |
First Address | Raleigh, NC 27615-3133 |
Second Address | Raleigh, NC 27615-2970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2014 |
Last Update Date | 29/05/2021 |