Provider Demographics
NPI:1104275031
Name:DEYOUNG, BETH (APRN)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:DEYOUNG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 EASTERN PKWY STE 2211
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1444
Mailing Address - Country:US
Mailing Address - Phone:502-635-2775
Mailing Address - Fax:502-371-0475
Practice Address - Street 1:1169 EASTERN PKWY STE 2211
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1444
Practice Address - Country:US
Practice Address - Phone:502-635-2775
Practice Address - Fax:502-371-0475
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28163941A163WR0006X
KY3010700363LF0000X, 363LP0808X
KY1133702163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health