Provider Demographics
NPI:1417426271
Name:YOUNG, BRENNA NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:NICOLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:BRENNA
Other - Middle Name:NICOLE
Other - Last Name:BECCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1363 KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-2103
Mailing Address - Country:US
Mailing Address - Phone:740-232-8180
Mailing Address - Fax:
Practice Address - Street 1:10 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6389
Practice Address - Country:US
Practice Address - Phone:304-243-8669
Practice Address - Fax:304-243-3825
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant