Provider Demographics
NPI:1083996714
Name:YOUNG, KELLY RAY (CRNP)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:RAY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:707W MARKET ST A
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2463
Mailing Address - Country:US
Mailing Address - Phone:256-262-9310
Mailing Address - Fax:
Practice Address - Street 1:185 CHATEAU DRIVE
Practice Address - Street 2:SUITE 302
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-7413
Practice Address - Country:US
Practice Address - Phone:256-885-1605
Practice Address - Fax:256-885-1905
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-117362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily