Provider Demographics
NPI:1972003663
Name:YOUNG, KRISTI (RN)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 E. 42ND ST.
Mailing Address - Street 2:SUITE 203 ATTN: PEDIATRIC DEPT
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762
Mailing Address - Country:US
Mailing Address - Phone:432-550-1721
Mailing Address - Fax:432-550-1717
Practice Address - Street 1:3800 E. 42ND ST.
Practice Address - Street 2:SUITE 203 ATTN: PEDIATRIC DEPT
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762
Practice Address - Country:US
Practice Address - Phone:432-550-1721
Practice Address - Fax:432-550-1717
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX617114163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics