Provider Demographics
NPI:1700189834
Name:YOUNG, PEGGY LYNN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:LYNN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2985 CORTEZ AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7554
Mailing Address - Country:US
Mailing Address - Phone:208-535-4302
Mailing Address - Fax:208-535-4315
Practice Address - Street 1:3200 CHANNING WAY
Practice Address - Street 2:STE 205
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7546
Practice Address - Country:US
Practice Address - Phone:208-535-4300
Practice Address - Fax:208-535-4315
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-12
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDNP-1027A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily