Provider Demographics
NPI:1891993028
Name:YOUNG, OLIVIA LOUISE (NP)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:LOUISE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 SANTA BELLA DR
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2917
Mailing Address - Country:US
Mailing Address - Phone:314-395-9322
Mailing Address - Fax:
Practice Address - Street 1:8701 SANTA BELLA DR
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-2917
Practice Address - Country:US
Practice Address - Phone:314-330-6959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18553363LP0808X
IA135519363LP0808X
MO2013026640363LP0808X
MDAC002461363LP0808X
CO0000337-C-NP363LP0808X
IL2090011202363LP0808X
OH15544-NP364SP0808X
AZAP7766363LP0808X
MO075572163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse