Provider Demographics
NPI:1538921804
Name:YOUNG, KEVIN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18585 KETTLERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW KNOXVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45871-9509
Mailing Address - Country:US
Mailing Address - Phone:419-979-8320
Mailing Address - Fax:
Practice Address - Street 1:11571 WELLS RD
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:OH
Practice Address - Zip Code:45302-9559
Practice Address - Country:US
Practice Address - Phone:419-489-3152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider