Provider Demographics
NPI:1801906987
Name:YOUNG, PATRICE DANITA (MSN, PMHCNS, BC)
Entity type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:DANITA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSN, PMHCNS, BC
Other - Prefix:
Other - First Name:PATTIE
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1901 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5707
Mailing Address - Country:US
Mailing Address - Phone:765-935-7284
Mailing Address - Fax:765-935-5002
Practice Address - Street 1:1901 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5707
Practice Address - Country:US
Practice Address - Phone:765-935-7284
Practice Address - Fax:765-935-5002
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000093A363LP0808X
IN28098082A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN70000093AOtherAPRN LICENSE
IN000000244564OtherANTHEM
IN485522000OtherMAGELLAN
IN200310370AMedicaid
IN28098082AOtherRN LICENSE
IN485522000OtherMAGELLAN
INP68710Medicare UPIN