Provider Demographics
NPI:1124298849
Name:YOUNG, REGINA M (NP)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-0839
Mailing Address - Country:US
Mailing Address - Phone:662-286-9883
Mailing Address - Fax:662-284-9836
Practice Address - Street 1:601 FOOTE ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-4834
Practice Address - Country:US
Practice Address - Phone:662-287-4424
Practice Address - Fax:662-287-2070
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR803797363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology