Provider Demographics
NPI:1558165548
Name:YOUNGER, KALEIGH REBECA (CPNP-PC)
Entity type:Individual
Prefix:
First Name:KALEIGH
Middle Name:REBECA
Last Name:YOUNGER
Suffix:
Gender:
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11240 HIGHWAY 49 STE C
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4132
Mailing Address - Country:US
Mailing Address - Phone:228-831-8800
Mailing Address - Fax:
Practice Address - Street 1:11240 HIGHWAY 49 STE C
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4132
Practice Address - Country:US
Practice Address - Phone:228-864-6230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907349363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics