Provider Demographics
NPI:1457991051
Name:DAVIS-YOUNG, SANDRA KAY (PMHNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:DAVIS-YOUNG
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 GREENWAY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-6439
Mailing Address - Country:US
Mailing Address - Phone:662-822-4012
Mailing Address - Fax:
Practice Address - Street 1:1254 GREENWAY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-6439
Practice Address - Country:US
Practice Address - Phone:662-822-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS860243163W00000X
MS903637363LP0808X
TN26781363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse