Provider Demographics
NPI:1033186135
Name:YOUNG, ROSLYN (APRN, BS)
Entity Type:Individual
Prefix:MS
First Name:ROSLYN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:APRN, BS
Other - Prefix:MRS
Other - First Name:ROSLYN
Other - Middle Name:
Other - Last Name:HASSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP,BS
Mailing Address - Street 1:496 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1827
Mailing Address - Country:US
Mailing Address - Phone:859-288-2392
Mailing Address - Fax:859-721-3918
Practice Address - Street 1:496 SOUTHLAND DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1827
Practice Address - Country:US
Practice Address - Phone:859-288-2425
Practice Address - Fax:859-288-7510
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002233363LP0808X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78011103Medicaid
000000391954OtherBCBS CKBH
KY30615058Medicaid
KY78011103Medicaid
KY30615058Medicaid
KY0331808Medicare ID - Type Unspecified
KY0947802Medicare ID - Type UnspecifiedCKBH
KY0912202Medicare ID - Type UnspecifiedHHC