Provider Demographics
NPI:1861842700
Name:YOUNG, KELLY MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELLE
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 1:2424 ERWIN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3825
Mailing Address - Country:US
Mailing Address - Phone:919-668-5055
Mailing Address - Fax:
Practice Address - Street 1:2424 ERWIN RD STE 201
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3825
Practice Address - Country:US
Practice Address - Phone:919-668-5055
Practice Address - Fax:919-668-5088
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical