Provider Demographics
NPI:1891041554
Name:YOUNG, ROBERT ANTHONY III (NP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTHONY
Last Name:YOUNG
Suffix:III
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 STILLMAN PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1455
Mailing Address - Country:US
Mailing Address - Phone:804-203-2855
Mailing Address - Fax:804-509-0538
Practice Address - Street 1:3800 STILLMAN PKWY STE 201
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1455
Practice Address - Country:US
Practice Address - Phone:804-203-2855
Practice Address - Fax:804-509-0538
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170246363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health