Provider Demographics
NPI:1417277062
Name:YOUNG, KATHLEEN E
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 IRON MOUND RD
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-5778
Mailing Address - Country:US
Mailing Address - Phone:405-282-6300
Mailing Address - Fax:405-282-6305
Practice Address - Street 1:2231 IRON MOUND RD
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-5778
Practice Address - Country:US
Practice Address - Phone:405-282-6300
Practice Address - Fax:405-282-6305
Is Sole Proprietor?:No
Enumeration Date:2010-06-06
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator