Provider Demographics
NPI:1750374203
Name:YOUNG, KAYLYNN C (PA)
Entity type:Individual
Prefix:
First Name:KAYLYNN
Middle Name:C
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAYLYNN
Other - Middle Name:C
Other - Last Name:SNODGRASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:17110 DALLAS PKWY
Mailing Address - Street 2:#100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1167
Mailing Address - Country:US
Mailing Address - Phone:972-380-7000
Mailing Address - Fax:972-380-9266
Practice Address - Street 1:17110 DALLAS PKWY
Practice Address - Street 2:#100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1167
Practice Address - Country:US
Practice Address - Phone:972-380-7000
Practice Address - Fax:972-380-9266
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04252363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D6498Medicare ID - Type Unspecified
TXQ46832Medicare UPIN