Provider Demographics
NPI:1679205173
Name:YOUNG, DAKOTA LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:LEE
Last Name:YOUNG
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 KOLLER TRL
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-7799
Mailing Address - Country:US
Mailing Address - Phone:479-275-6423
Mailing Address - Fax:
Practice Address - Street 1:1500 DODSON AVE STE 285
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5182
Practice Address - Country:US
Practice Address - Phone:479-709-7025
Practice Address - Fax:479-424-1892
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR220898363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner