Provider Demographics
NPI:1245125327
Name:YOUNG, JESSIE (PA-C)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PARKLANDS DR UNIT 1637
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5192
Mailing Address - Country:US
Mailing Address - Phone:678-777-5903
Mailing Address - Fax:
Practice Address - Street 1:11 PARKLANDS DR UNIT 1637
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5192
Practice Address - Country:US
Practice Address - Phone:678-777-5903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant