Provider Demographics
NPI:1215352166
Name:YOUNG, JEFFERY A JR (LPN)
Entity type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:A
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-2142
Mailing Address - Country:US
Mailing Address - Phone:740-507-9706
Mailing Address - Fax:
Practice Address - Street 1:405 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-2142
Practice Address - Country:US
Practice Address - Phone:740-507-9706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN109246164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse