Basic Information
| Provider Information | |||||||||
| NPI: | 1699929505 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | RYAN | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3904 TERRACE HEIGHTS DR STE D | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989011568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099021931 | ||||||||
| FaxNumber: | 5092488291 | ||||||||
| Practice Location | |||||||||
| Address1: | 3904 TERRACE HEIGHTS DRIVE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989011568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099021931 | ||||||||
| FaxNumber: | 5099021970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2008 | ||||||||
| LastUpdateDate: | 09/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP60052188 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP2300X | AP60052188 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LF0000X | AP60052188 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | AP60052188 | 01 | WA | STATE ARNP LICENSE | OTHER |