Provider Demographics
NPI:1982383519
Name:YOUNG, TIFFANY LEEANNE (CFNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEEANNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3131
Mailing Address - Country:US
Mailing Address - Phone:417-782-5522
Mailing Address - Fax:417-782-5866
Practice Address - Street 1:2719 E 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3131
Practice Address - Country:US
Practice Address - Phone:417-782-5522
Practice Address - Fax:417-782-5866
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023028076363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care