Provider Demographics
NPI:1952339335
Name:YOUNG, GERALDINE Q (CFNP)
Entity Type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:Q
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:DR
Other - First Name:GERALDINE
Other - Middle Name:Q
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:PO BOX 3939
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704-3939
Mailing Address - Country:US
Mailing Address - Phone:601-941-7181
Mailing Address - Fax:601-941-7181
Practice Address - Street 1:1573 JANE ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7843
Practice Address - Country:US
Practice Address - Phone:601-941-7181
Practice Address - Fax:601-941-7181
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR861956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05933790Medicaid
MSC01051Medicare Oscar/Certification
MS05933790Medicaid
MS251850Medicare Oscar/Certification
MS251933Medicare Oscar/Certification
MSQ67184Medicare UPIN