Provider Demographics
NPI:1851005771
Name:YOUNG, PEYTEN (PA-C)
Entity Type:Individual
Prefix:
First Name:PEYTEN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 120TH AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2196
Mailing Address - Country:US
Mailing Address - Phone:616-396-5855
Mailing Address - Fax:
Practice Address - Street 1:370 120TH AVE STE 20
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2196
Practice Address - Country:US
Practice Address - Phone:616-396-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601011579TMP23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant