Provider Demographics
NPI:1609313089
Name:YOUNG, LEE PHILLIPY (RN, BSN)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:PHILLIPY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LANSDOWNE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2044
Mailing Address - Country:US
Mailing Address - Phone:865-201-1121
Mailing Address - Fax:
Practice Address - Street 1:600 RAYDER AVE
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1050
Practice Address - Country:US
Practice Address - Phone:865-458-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000101560163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health