Provider Demographics
NPI:1780214205
Name:YOUNG, ALEXIS
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 COUNTY ROAD 461
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36280-5864
Mailing Address - Country:US
Mailing Address - Phone:256-298-0035
Mailing Address - Fax:
Practice Address - Street 1:284 COUNTY ROAD 461
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:AL
Practice Address - Zip Code:36280-5864
Practice Address - Country:US
Practice Address - Phone:256-298-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS12653390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program