Provider Demographics
NPI:1093470130
Name:YOUNG, KERRY GENE
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:GENE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:GENE
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 N MCCRACKEN ST
Mailing Address - Street 2:
Mailing Address - City:CHOUTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74337-3219
Mailing Address - Country:US
Mailing Address - Phone:539-900-5485
Mailing Address - Fax:
Practice Address - Street 1:101 N MCCRACKEN ST
Practice Address - Street 2:
Practice Address - City:CHOUTEAU
Practice Address - State:OK
Practice Address - Zip Code:74337-3219
Practice Address - Country:US
Practice Address - Phone:539-900-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist