Provider Demographics
NPI:1194280289
Name:YOUNG, REBECCA KLEIN
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KLEIN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ELLEN
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 FRANCAM DR STE 120
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-4500
Mailing Address - Country:US
Mailing Address - Phone:910-487-1100
Mailing Address - Fax:
Practice Address - Street 1:40 AUTUMN FERN TRL
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-5155
Practice Address - Country:US
Practice Address - Phone:910-364-0971
Practice Address - Fax:910-814-4064
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08802363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant