Provider Demographics
NPI:1437279064
Name:YOUNG-SHIELDS, YAKIMA (APN, HSN)
Entity Type:Individual
Prefix:
First Name:YAKIMA
Middle Name:
Last Name:YOUNG-SHIELDS
Suffix:
Gender:F
Credentials:APN, HSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 W BELL RD
Mailing Address - Street 2:STE 105
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-1283
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1120 SHACKELFORD RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-4369
Practice Address - Country:US
Practice Address - Phone:314-291-4420
Practice Address - Fax:314-291-6086
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10775363LA2200X
MO135549363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO836513572Medicare PIN