Basic Information
| Provider Information | |||||||||
| NPI: | 1114504834 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | FLETCHER | ||||||||
| MiddleName: | GRAHAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3639 WATER MILL AVE | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421045527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707840968 | ||||||||
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| Practice Location | |||||||||
| Address1: | 305 LANGDON ST | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425032750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064515093 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2021 | ||||||||
| LastUpdateDate: | 04/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.