Provider Demographics
NPI:1063798775
Name:YOUNG, JOY ANN (RD/LD)
Entity type:Individual
Prefix:MISS
First Name:JOY
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16908 SIMSBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-2210
Mailing Address - Country:US
Mailing Address - Phone:512-466-9928
Mailing Address - Fax:512-438-2729
Practice Address - Street 1:16908 SIMSBROOK DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-2210
Practice Address - Country:US
Practice Address - Phone:512-466-9928
Practice Address - Fax:512-438-2729
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL676183133V00000X
TXDT03932133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered