Provider Demographics
NPI:1881663128
Name:YOUNG, RICHARD O (CRNA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:O
Last Name:YOUNG
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2561
Mailing Address - Country:US
Mailing Address - Phone:615-865-0944
Mailing Address - Fax:615-868-1100
Practice Address - Street 1:500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5031
Practice Address - Country:US
Practice Address - Phone:615-865-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10568367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY700001100OtherKY MEDICAID
TN10069699OtherAMERIGROUP
TN3602191Medicaid
TN4130656OtherBCBS
TN10069699OtherAMERIGROUP