Provider Demographics
NPI:1194177022
Name:YOUNG, STEPHANIE R (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8360 S EMERSON AVE
Mailing Address - Street 2:100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8745
Mailing Address - Country:US
Mailing Address - Phone:317-859-2535
Mailing Address - Fax:
Practice Address - Street 1:8360 S EMERSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8746
Practice Address - Country:US
Practice Address - Phone:317-859-2535
Practice Address - Fax:317-859-2540
Is Sole Proprietor?:No
Enumeration Date:2016-07-03
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28179328A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201389510Medicaid