Provider Demographics
NPI:1336615590
Name:DEYOUNG, NICHOLAS JON (PA-C)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JON
Last Name:DEYOUNG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:77 E THOMAS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3100
Mailing Address - Country:US
Mailing Address - Phone:602-222-1900
Mailing Address - Fax:602-557-0002
Practice Address - Street 1:5058 E SOUTHERN AVE STE 102
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2771
Practice Address - Country:US
Practice Address - Phone:602-222-1900
Practice Address - Fax:480-834-6181
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2022-09-12
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty