| Organization Name: | YOUNG MEDICAL CLINIC LLC |
| NPI Number: | 1053677377 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DANIEL YOUNG (PRESIDENT) |
| Mailing Address: | 1302 W Collin Raye Dr Ste A De Queen |
| State: | AR US |
| Postal Code: | 718322588 |
| Phone Number: | 8706424730 |
| Fax Number: | 8703817273 |
| NPI Enumeration Date: | 04/11/2012 |
| NPI Last Update Date: | 06/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |