Basic Information
| Provider Information | |||||||||
| NPI: | 1952526964 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | WES | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6037 26 RD | ||||||||
| Address2: | |||||||||
| City: | FOWLER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6206465589 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 ROSS BLVD | ||||||||
| Address2: | B2A | ||||||||
| City: | DODGE CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202273141 | ||||||||
| FaxNumber: | 6202278095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1500075 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.