Provider Demographics
NPI:1760433882
Name:YOUNG, DANIEL T (APN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:YOUNG
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 W COLLIN RAYE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-2502
Mailing Address - Country:US
Mailing Address - Phone:870-584-0284
Mailing Address - Fax:
Practice Address - Street 1:1302 W COLLIN RAYE DR
Practice Address - Street 2:SUITE A
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2502
Practice Address - Country:US
Practice Address - Phone:870-584-0284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01914363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y728OtherBCBS
AR157468758Medicaid
AR157468758Medicaid
AR5Y728Medicare ID - Type Unspecified