Provider Demographics
NPI:1316059702
Name:YOUNGS, JENNIFER MICHELE (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MICHELE
Last Name:YOUNGS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2352 MEADOWS BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8406
Mailing Address - Country:US
Mailing Address - Phone:720-455-3775
Mailing Address - Fax:720-455-3776
Practice Address - Street 1:2352 MEADOWS BLVD
Practice Address - Street 2:STE 300
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8406
Practice Address - Country:US
Practice Address - Phone:720-455-3775
Practice Address - Fax:720-455-3776
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17514363A00000X
COPA.0002340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95689834Medicaid