Individual provider Active NPI

Tonya Rachel Young, FNP

  • Family Nurse Practitioner
  • Camden on Gauley, WV
National Provider Identifier
1114215779
Registry record updated Feb 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
72424 Issued in WV
Practice address
10003 Webster Rd
Camden on Gauley, WV 26208-7713
Phone
(304) 226-5725
Fax
(304) 226-3274
NPI assigned
Jul 18, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 72424 WV Primary

Addresses

Primary practice location

10003 Webster Rd
Camden on Gauley, WV 26208-7713

Mailing address

10003 Webster Rd
Camden on Gauley, WV 26208-7713
Phone (304) 226-5725

Other identifiers 1

IdentifierTypeStateIssuer
3810021288MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110907001115 WV Practitioner - Nurse Practitioner 5597935247 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
West Virginia University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Braxton County Memorial HospitalGroup PAC ID 5193717759, 46 clinicians

Practice addresses (Care Compare)

617 River St
Gassaway, WV 26624-1137
Phone (304) 364-2401

Hospital & facility affiliations

  • Braxton County Memorial Hospital, Inc Hospital, Gassaway, WV, CCN 511308
  • United Hospital Center, Inc Hospital, Bridgeport, WV, CCN 510006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
72424WVMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Braxton County Memorial Hospital CurrentSince Dec 26, 2023 Accepting new patients
Braxton County Memorial Hospital CurrentSince Dec 26, 2023 Accepting new patients
Community Care of West Virginia, Inc. Past Accepting new patients

Locations

617 River St
Gassaway, WV 26624
Phone (304) 364-2401

100 Hoylman Dr
Gassaway, WV 26624
Phone (304) 364-1046

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1310947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613692800000",
    "number": "1114215779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10003 WEBSTER RD",
            "city": "CAMDEN ON GAULEY",
            "state": "WV",
            "postal_code": "262087713",
            "telephone_number": "304-226-5725",
            "fax_number": "304-226-3274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10003 WEBSTER RD",
            "city": "CAMDEN ON GAULEY",
            "state": "WV",
            "postal_code": "262087713",
            "telephone_number": "304-226-5725",
            "fax_number": "304-226-3274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "TONYA",
        "middle_name": "RACHEL",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-18",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "72424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810021288",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Camden on Gauley, WV

Sources for this page

Verify at the official NPI Registry.