Provider Demographics
NPI:1952658403
Name:YOUNG, JIM BRIAN (APN)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:BRIAN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E HILL AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37915-2566
Mailing Address - Country:US
Mailing Address - Phone:865-862-3563
Mailing Address - Fax:865-544-1861
Practice Address - Street 1:576 FORT LOUDOUN MEDICAL CENTER DR STE 203
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5676
Practice Address - Country:US
Practice Address - Phone:865-271-6095
Practice Address - Fax:865-271-6096
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN16874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ000026Medicaid
TN10350I2813Medicare PIN