Provider Demographics
NPI:1992380919
Name:YOUNG, ASHLEY LYNN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LYNN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:LYNN
Other - Last Name:COATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1079 S ANCONA AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616
Mailing Address - Country:US
Mailing Address - Phone:208-428-4830
Mailing Address - Fax:541-550-2286
Practice Address - Street 1:1079 S ANCONA AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616
Practice Address - Country:US
Practice Address - Phone:208-428-4830
Practice Address - Fax:541-550-2286
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily