Provider Demographics
NPI:1811068133
Name:YOUNG, KIMBERLY M (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:M
Other - Last Name:SHOSSNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1813 BELTLINE RD SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-5506
Mailing Address - Country:US
Mailing Address - Phone:256-353-3500
Mailing Address - Fax:256-353-6876
Practice Address - Street 1:1813 BELTLINE RD SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5506
Practice Address - Country:US
Practice Address - Phone:256-353-3500
Practice Address - Fax:256-353-6876
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-098727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
510I500055Medicare PIN
510I500055Medicare UPIN