Provider Demographics
NPI:1649947383
Name:YOUNTS, SYDNEY BLAKE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SYDNEY
Middle Name:BLAKE
Last Name:YOUNTS
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:PO BOX 5278
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602
Mailing Address - Country:US
Mailing Address - Phone:423-753-4000
Mailing Address - Fax:423-753-4004
Practice Address - Street 1:2244 BOONES CREEK ROAD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615
Practice Address - Country:US
Practice Address - Phone:423-753-4000
Practice Address - Fax:423-753-4004
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-29
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363A00000X
TN4744363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant