Provider Demographics
NPI:1770030827
Name:YOUNG, KIMBERLY (MAED)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-9525
Mailing Address - Country:US
Mailing Address - Phone:810-853-3898
Mailing Address - Fax:
Practice Address - Street 1:795 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9525
Practice Address - Country:US
Practice Address - Phone:810-853-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other