Provider Demographics
NPI:1558994129
Name:YOUNG, JACY KAY (CPO)
Entity Type:Individual
Prefix:
First Name:JACY
Middle Name:KAY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 E ALLUVIAL AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2686
Mailing Address - Country:US
Mailing Address - Phone:559-298-0321
Mailing Address - Fax:559-298-7164
Practice Address - Street 1:1247 E ALLUVIAL AVE STE 112
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2686
Practice Address - Country:US
Practice Address - Phone:559-298-0321
Practice Address - Fax:559-298-7164
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist