Provider Demographics
NPI:1013744028
Name:YOUNG-MCCONICO, CAROLYN (LPN)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:
Last Name:YOUNG-MCCONICO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29151-0591
Mailing Address - Country:US
Mailing Address - Phone:803-774-3088
Mailing Address - Fax:
Practice Address - Street 1:410 W LIBERTY ST STE 200
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4865
Practice Address - Country:US
Practice Address - Phone:803-774-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-2185164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse