Provider Demographics
NPI:1356312912
Name:YOUNG, KEVIN W (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:W
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-3707
Mailing Address - Country:US
Mailing Address - Phone:337-224-8620
Mailing Address - Fax:337-216-1500
Practice Address - Street 1:315 E 9TH ST
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-3707
Practice Address - Country:US
Practice Address - Phone:337-224-8620
Practice Address - Fax:337-216-1500
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAM.D.09967R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CH72OtherMEDICARE CORPORATION #
LA1997846Medicaid
LA5U741Medicare PIN
LAF89765Medicare UPIN