Provider Demographics
NPI:1417842568
Name:YOUNG, DESTINY ANDREA
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:ANDREA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 W 52ND DR APT M343
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-1382
Mailing Address - Country:US
Mailing Address - Phone:317-499-9681
Mailing Address - Fax:
Practice Address - Street 1:922 W 52ND DR APT M343
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-1382
Practice Address - Country:US
Practice Address - Phone:317-499-9681
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 Licenses
StateLicense IDTaxonomies
INCNA2202350376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide