Provider Demographics
NPI:1124394986
Name:YOUNGBLOOD, KATRINA LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:LYNN
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:LYNN
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:76 PEACHTREE ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ASHEVLLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3505
Mailing Address - Country:US
Mailing Address - Phone:828-274-3477
Mailing Address - Fax:828-274-7407
Practice Address - Street 1:76 PEACHTREE ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHEVLLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3505
Practice Address - Country:US
Practice Address - Phone:828-274-3477
Practice Address - Fax:828-274-7407
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC210841163W00000X
NC090064367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8054218Medicaid
NCQ39556AMedicare PIN