Provider Demographics
NPI:1316071285
Name:YOUNG, PATRICIA LEE (APRN,BC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:PATTY
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:2000 E GREENVILLE ST
Mailing Address - Street 2:SUITE #1600
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1580
Mailing Address - Country:US
Mailing Address - Phone:864-716-6008
Mailing Address - Fax:864-716-6732
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:SUITE #1600
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1719
Practice Address - Country:US
Practice Address - Phone:864-716-6008
Practice Address - Fax:864-716-6732
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1445363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0114Medicaid
SCQ314804871Medicare ID - Type Unspecified
SCNP0114Medicaid