Provider Demographics
NPI:1083187942
Name:YOUNG, KAILA ANNE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:ANNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:KAILA
Other - Middle Name:ANNE
Other - Last Name:MEADOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:616 SAW CHEEK LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2476
Mailing Address - Country:US
Mailing Address - Phone:803-298-0730
Mailing Address - Fax:
Practice Address - Street 1:2451 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2026
Practice Address - Country:US
Practice Address - Phone:470-985-2247
Practice Address - Fax:833-902-3467
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22501363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology