Provider Demographics
NPI:1093022857
Name:YOUNG, SANDRA (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 N BECKLEY AVE
Mailing Address - Street 2:PAV III STE#268
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1259
Mailing Address - Country:US
Mailing Address - Phone:214-947-4400
Mailing Address - Fax:214-947-4404
Practice Address - Street 1:981 STATE HIGHWAY 121 STE 1140
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6148
Practice Address - Country:US
Practice Address - Phone:469-697-5100
Practice Address - Fax:469-697-5105
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8347NKOtherBLUE CROSS AND BLUE SHIELD OF TEXAS
TXTXB118163Medicare PIN
TXTXB118166Medicare PIN
TX219410201Medicaid
TX219410202Medicaid
TXTXB118170Medicare PIN