Provider Demographics
NPI:1619905759
Name:YOUNG, VERNITA REENA (MA/ATC)
Entity Type:Individual
Prefix:MS
First Name:VERNITA
Middle Name:REENA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 WINSTON DR
Mailing Address - Street 2:K-7
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-4607
Mailing Address - Country:US
Mailing Address - Phone:931-529-4617
Mailing Address - Fax:931-525-6689
Practice Address - Street 1:1585 3RD ST
Practice Address - Street 2:
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-5102
Practice Address - Country:US
Practice Address - Phone:931-529-4617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer