Provider Demographics
NPI:1699312926
Name:YOUNG, VIVIAN (NP)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8410 CHICKAMAUGA LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6370
Mailing Address - Country:US
Mailing Address - Phone:713-636-3889
Mailing Address - Fax:832-649-4403
Practice Address - Street 1:8700 COMMERCE PARK DR STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7431
Practice Address - Country:US
Practice Address - Phone:713-636-3889
Practice Address - Fax:832-649-4403
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP144201363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4063208-06Medicaid