Provider Demographics
NPI:1649404757
Name:YOUNG, AMY B (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SIGMA DR
Mailing Address - Street 2:STE. 100
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7715
Mailing Address - Country:US
Mailing Address - Phone:843-873-1720
Mailing Address - Fax:843-873-1108
Practice Address - Street 1:213 W 4TH NORTH ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6541
Practice Address - Country:US
Practice Address - Phone:843-873-0681
Practice Address - Fax:843-873-8749
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3891363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1429Medicaid
SCP00871891OtherRR MEDICARE
SCNP1429Medicaid
SCAA36948798Medicare PIN
SCAA36947126Medicare PIN
SCAA36947499Medicare PIN