Provider Demographics
NPI:1699929505
Name:YOUNG, PHILIP RYAN (ARNP)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:RYAN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 TERRACE HEIGHTS DR STE D
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-1568
Mailing Address - Country:US
Mailing Address - Phone:509-902-1931
Mailing Address - Fax:509-248-8291
Practice Address - Street 1:3904 TERRACE HEIGHTS DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-1568
Practice Address - Country:US
Practice Address - Phone:509-902-1931
Practice Address - Fax:509-902-1970
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60052188363L00000X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60052188OtherSTATE ARNP LICENSE