Doctor Name: | MR. MICHAEL DUANE YOUNG |
NPI Number: | 1205181054 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP-C |
License Number: | 16829 |
Business Practice Address: | 5545 Little Debbie Pkwy Ooltewah, TN - 373634357 |
Business Phone Number: | 4239335155 |
Business Fax Number: | |
Mailing Address: | 3790 Bentwood Cove Dr, APISON |
State: | TN |
Postal Code: | 373027531 |
Phone Number: | 4239335155 |
Fax Number: | |
NPI Enumeration Date: | 07/18/2012 |
NPI Last Update Date: | 07/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 16829 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |