Provider Demographics
NPI:1487203329
Name:YOUNG, KURSTI (LVN)
Entity Type:Individual
Prefix:
First Name:KURSTI
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 ETHAN DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-7719
Mailing Address - Country:US
Mailing Address - Phone:402-281-8225
Mailing Address - Fax:
Practice Address - Street 1:1117 ETHAN DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-7719
Practice Address - Country:US
Practice Address - Phone:402-281-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX349718164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse