Provider Demographics
NPI:1639707151
Name:YOUNG, BRIANNA (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 N RAVEN RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-1941
Mailing Address - Country:US
Mailing Address - Phone:719-332-5811
Mailing Address - Fax:
Practice Address - Street 1:903 N RAVEN RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-1941
Practice Address - Country:US
Practice Address - Phone:719-332-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant