Provider Demographics
NPI:1578588992
Name:YOUNG, KATHLEEN M (RNC, NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RNC, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SUNNYVIEW LN STE 201
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3128
Mailing Address - Country:US
Mailing Address - Phone:406-752-5252
Mailing Address - Fax:406-752-5261
Practice Address - Street 1:115 HEAVENS PEAK DR
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-7141
Practice Address - Country:US
Practice Address - Phone:406-752-8821
Practice Address - Fax:406-752-5261
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAPRN100189363LW0102X
MTRN13548363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000371160OtherBCBS
MT4302547Medicaid
MT500026892OtherRAILROAD MEDICARE
MT500026892OtherRAILROAD MEDICARE
MT000083760Medicare ID - Type Unspecified