Provider Demographics
NPI:1952526964
Name:YOUNG, WES L (PAC)
Entity Type:Individual
Prefix:MR
First Name:WES
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6037 26 RD
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:KS
Mailing Address - Zip Code:67844
Mailing Address - Country:US
Mailing Address - Phone:620-646-5589
Mailing Address - Fax:
Practice Address - Street 1:100 ROSS BLVD
Practice Address - Street 2:B2A
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801
Practice Address - Country:US
Practice Address - Phone:620-227-3141
Practice Address - Fax:620-227-8095
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500075363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant