Provider Demographics
NPI:1477884658
Name:YOUNG, WAKISHA RENEE (RN)
Entity type:Individual
Prefix:MS
First Name:WAKISHA
Middle Name:RENEE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:141 PRINCETON DR NE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-6311
Mailing Address - Country:US
Mailing Address - Phone:478-251-8101
Mailing Address - Fax:
Practice Address - Street 1:141 PRINCETON DR NE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-6311
Practice Address - Country:US
Practice Address - Phone:478-251-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2024-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN229210163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse