Provider Demographics
NPI:1205503653
Name:YOUNG, ADRIANE JALEEL
Entity type:Individual
Prefix:
First Name:ADRIANE
Middle Name:JALEEL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 S. DREXEL AVE APT 1212
Mailing Address - Street 2:
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6451
Mailing Address - Country:US
Mailing Address - Phone:405-706-8107
Mailing Address - Fax:
Practice Address - Street 1:8800 S. DREXEL AVE APT 1212
Practice Address - Street 2:
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73159-6451
Practice Address - Country:US
Practice Address - Phone:405-706-8107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
16041177OtherUNITED HEALTHCARE