Provider Demographics
NPI:1689874463
Name:MULHOLLAND-YOUNGE, BARBARA ANN (ANP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:MULHOLLAND-YOUNGE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:A
Other - Last Name:MENKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9915 KENNERLY RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2703
Mailing Address - Country:US
Mailing Address - Phone:314-843-4794
Mailing Address - Fax:314-843-9256
Practice Address - Street 1:9915 KENNERLY RD
Practice Address - Street 2:SUITE J
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2703
Practice Address - Country:US
Practice Address - Phone:314-843-4794
Practice Address - Fax:314-843-9256
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO063375363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO124510005Medicare PIN