Provider Demographics
NPI:1952302747
Name:YOUNG, KATHRYN LOSHARON (FNPC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:LOSHARON
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 723
Mailing Address - Street 2:980 MAIN ST.
Mailing Address - City:FAIRPLAY
Mailing Address - State:CO
Mailing Address - Zip Code:80440-0723
Mailing Address - Country:US
Mailing Address - Phone:719-836-3455
Mailing Address - Fax:719-836-1792
Practice Address - Street 1:980 MAIN ST.
Practice Address - Street 2:
Practice Address - City:FAIRPLAY
Practice Address - State:CO
Practice Address - Zip Code:80440-0723
Practice Address - Country:US
Practice Address - Phone:719-836-3455
Practice Address - Fax:719-836-1792
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07100753Medicaid
COYO634320OtherBLUE CROSS
CO841202560-01OtherCO PACIFICARE
COR19791Medicare UPIN
COYO634320OtherBLUE CROSS