Provider Demographics
NPI:1760856017
Name:YOUNG, SHANCEY (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHANCEY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 HUNTER HL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-8678
Mailing Address - Country:US
Mailing Address - Phone:601-507-7719
Mailing Address - Fax:
Practice Address - Street 1:2550 FLOWOOD DR STE 300
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9306
Practice Address - Country:US
Practice Address - Phone:601-420-0034
Practice Address - Fax:601-420-5482
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901422363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily