1518664861 NPI number — KAY LAVETTE YOUNG HEALTH EDUCATOR

Table of content: KAY LAVETTE YOUNG HEALTH EDUCATOR (NPI 1518664861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518664861 NPI number — KAY LAVETTE YOUNG HEALTH EDUCATOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
KAY
Provider Middle Name:
LAVETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HEALTH EDUCATOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOUNG
Provider Other First Name:
KAY
Provider Other Middle Name:
LAVETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
HEALTH EDUCATOR
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1518664861
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 SHADOWLANE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLY SPRINGS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38635-3148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-544-6411
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 SHADOWLANE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLY SPRINGS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38635-3148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-544-6411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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