Provider Demographics
NPI:1740616564
Name:YOU, QUINCY (CAA)
Entity Type:Individual
Prefix:MR
First Name:QUINCY
Middle Name:
Last Name:YOU
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:714 FM 1960 RD W
Practice Address - Street 2:SUITE 206
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3405
Practice Address - Country:US
Practice Address - Phone:281-880-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1664367H00000X
IN75000072A367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant