Provider Demographics
NPI:1033109772
Name:YOUNG, KRISTINE L (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 SE CABOT DR
Mailing Address - Street 2:SUITE B101
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3715
Mailing Address - Country:US
Mailing Address - Phone:360-675-6648
Mailing Address - Fax:360-679-2487
Practice Address - Street 1:275 SE CABOT DR
Practice Address - Street 2:SUITE B101
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3715
Practice Address - Country:US
Practice Address - Phone:360-675-6648
Practice Address - Fax:360-679-2487
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005064363AM0700X
VA0110004268363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP73421Medicare UPIN
WA8862100Medicare PIN
VAGC1100Medicare PIN