Provider Demographics
NPI:1942856562
Name:YOUNG, LAY'C KATHLEEN (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAY'C
Middle Name:KATHLEEN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 TRYON RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-8311
Mailing Address - Country:US
Mailing Address - Phone:430-200-4350
Mailing Address - Fax:833-491-2722
Practice Address - Street 1:515 N 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-6546
Practice Address - Country:US
Practice Address - Phone:903-475-2713
Practice Address - Fax:903-942-2930
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP141594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily