Michelle R Young, LDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

164004672 Issued in IL

Practice address

1025 Maine St
Quincy, IL 62301-4096

Phone

(217) 222-6550

Fax

(217) 277-2253

NPI assigned

Mar 17, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Michelle R Grimsley Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1053996397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014096",
            "telephone_number": "217-222-6550",
            "fax_number": "217-277-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014096",
            "telephone_number": "217-222-6550",
            "fax_number": "217-277-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "MICHELLE",
        "middle_name": "R",
        "credential": "LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-17",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MO",
            "license": "2007027443",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IA",
            "license": "096391",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164004672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MICHELLE",
            "last_name": "GRIMSLEY",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Scott J Wright, M.D.
• Christopher D. Wuerzburger, DPT
• Niharika Yedla, M.D.
• Constance Y Yoder, NP
• Charley Young, MS,ATC
• Young Woo Yu, M.D.
• Angela Marie Zanger, MS, RD, LDN
• Brenna N Zanger, LDN
• Jay Zanger, ATC, PTA
• Kimberly Zanger, NP

• Registered Dietitian in Quincy, IL
• Providers in Quincy, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.