Provider Demographics
NPI:1629036785
Name:YOUNG, TRACY P (CRNA)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:P
Last Name:YOUNG
Suffix:
Gender:M
Credentials:CRNA
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 20452
Mailing Address - Street 2:YPS-CRED
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0452
Mailing Address - Country:US
Mailing Address - Phone:614-442-2406
Mailing Address - Fax:614-442-2410
Practice Address - Street 1:1100 ANDRE ST STE 300
Practice Address - Street 2:YPS ANESTHESIA
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2159
Practice Address - Country:US
Practice Address - Phone:337-364-9225
Practice Address - Fax:337-364-6094
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN085074367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1111155Medicaid
TX8082UUOtherBCBS TX
TX198748905Medicaid
LA1629036785OtherBCBS LA
TX198748902Medicaid
LA1111155Medicaid
LA1629036785OtherBCBS LA
TX198748905Medicaid