Provider Demographics
NPI:1558632562
Name:YOUNG, LORI (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 RIVER OAKS DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9530
Mailing Address - Country:US
Mailing Address - Phone:601-939-9923
Mailing Address - Fax:
Practice Address - Street 1:1040 RIVER OAKS DR
Practice Address - Street 2:SUITE 302
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9530
Practice Address - Country:US
Practice Address - Phone:601-939-9923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR889448363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS354603YRH2Medicare PIN