Provider Demographics
NPI:1750899142
Name:YOUNG, WILLIAM TRAVIS (ARNP, FNP-C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TRAVIS
Last Name:YOUNG
Suffix:
Gender:M
Credentials:ARNP, FNP-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 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 VIOLET RD
Practice Address - Street 2:
Practice Address - City:CRITTENDEN
Practice Address - State:KY
Practice Address - Zip Code:41030-8956
Practice Address - Country:US
Practice Address - Phone:859-903-0268
Practice Address - Fax:859-428-1444
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011373A363L00000X
FL9330723363LF0000X
KY3013589363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily