Provider Demographics
NPI:1952494502
Name:YOUNG, GLENDA J (DPM)
Entity Type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:J
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E. 13 ST.
Mailing Address - Street 2:
Mailing Address - City:FT. SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701
Mailing Address - Country:US
Mailing Address - Phone:620-223-6118
Mailing Address - Fax:
Practice Address - Street 1:6 E 13TH ST
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-2625
Practice Address - Country:US
Practice Address - Phone:620-223-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSP-237213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST89131Medicare UPIN
MO0001843AMedicare ID - Type Unspecified
KS006754Medicare ID - Type Unspecified