Provider Demographics
NPI:1831114958
Name:YOUNG-WALKER, LAINE MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:LAINE
Middle Name:MICHELLE
Last Name:YOUNG-WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAINE
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:3 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-884-1130
Practice Address - Fax:573-884-5936
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1142382084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203967419Medicaid
MOR64C485Medicare ID - Type Unspecified
MO203967419Medicaid
MO152360121Medicare PIN