Provider Demographics
NPI:1548477367
Name:YOUNG, DENISE EADY (FNP-BC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:EADY
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:562-276-4825
Practice Address - Street 1:5605 N MACARTHUR BLVD STE 400
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2693
Practice Address - Country:US
Practice Address - Phone:888-562-5442
Practice Address - Fax:562-276-4825
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX650475363LF0000X
TXAP108722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160933102Medicaid
TX160933104Medicaid
TX160933103Medicaid
TX160933103Medicaid
TX160933104Medicaid
TX8L19238Medicare PIN