Provider Demographics
NPI:1669664876
Name:YOUNG, ROCHELLE ROCHA (FNP-C, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:ROCHA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNP-C, FNP-BC
Other - Prefix:MS
Other - First Name:ROCHELLE
Other - Middle Name:ROCHA
Other - Last Name:SANDIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C, FNP-BC
Mailing Address - Street 1:100 MEADOW WOODS CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-6029
Mailing Address - Country:US
Mailing Address - Phone:601-826-6200
Mailing Address - Fax:
Practice Address - Street 1:1500 E WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5116
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-11
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS863887363LP0808X
MSR863887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08580270Medicaid
MS08580270Medicaid