Provider Demographics
NPI:1194164863
Name:YOUNG-REESE, HOLLY ROCHELLE (NP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ROCHELLE
Last Name:YOUNG-REESE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:R
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9821 LIMA RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-9280
Practice Address - Country:US
Practice Address - Phone:260-240-5027
Practice Address - Fax:260-209-5119
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28132047A363L00000X
IN71004525A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201166570Medicaid
IN201166570Medicaid