Provider Demographics
NPI:1790473692
Name:YOUNG, PATRICIA JO (CNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JO
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 MORAN ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4337
Mailing Address - Country:US
Mailing Address - Phone:208-529-0342
Mailing Address - Fax:208-529-6981
Practice Address - Street 1:1810 MORAN ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4337
Practice Address - Country:US
Practice Address - Phone:208-529-0342
Practice Address - Fax:208-529-6981
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID73974363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty