Provider Demographics
NPI:1942326152
Name:YOUNG, DARRELL L (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:L
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 1:12752 KINGSTON PIKE
Mailing Address - Street 2:STE E202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0948
Mailing Address - Country:US
Mailing Address - Phone:865-777-0909
Mailing Address - Fax:865-777-0910
Practice Address - Street 1:18797 ALBERTA STREET
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-2127
Practice Address - Country:US
Practice Address - Phone:865-777-0909
Practice Address - Fax:865-777-0910
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008863367500000X
TN39899367500000X
TNRN39899367500000X
TNAPN8863367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00632164OtherRAILROAD MEDICARE PIN
TN1507047Medicaid
TN3601205Medicaid
TN4103902OtherBCBS TN PROVIDER #
TN4193316OtherBLUE CROSS/BLUE SHIELD
KY74003955Medicaid
TN36012052Medicare PIN
TN4193316OtherBLUE CROSS/BLUE SHIELD