Provider Demographics
NPI:1154659431
Name:YOUNG, CHRISTIAN CASEY (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:CASEY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:CASEY
Other - Last Name:BOGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1743
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-1743
Mailing Address - Country:US
Mailing Address - Phone:530-524-6045
Mailing Address - Fax:
Practice Address - Street 1:2830 EAST ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-3408
Practice Address - Country:US
Practice Address - Phone:530-365-2545
Practice Address - Fax:530-365-3871
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA660294163W00000X
CA95010353363LF0000X
WAAP60672874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse