Individual provider Active NPI

Crystal Dawn Young, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Gastonia, NC
National Provider Identifier
1164094454
Registry record updated Feb 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
5014609 Issued in NC
Practice address
1337 E Garrison Blvd
Gastonia, NC 28054-5127
Phone
(704) 865-3848
Fax
(704) 854-3086
NPI assigned
Jul 15, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 5014609 NC Primary

Addresses

Primary practice location

1337 E Garrison Blvd
Gastonia, NC 28054-5127

Mailing address

PO Box 744786
Atlanta, GA 30374-4786
Phone (704) 834-2450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20210908002737 NC Practitioner - Nurse Practitioner 6204232762 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Caromont Medical Group IncGroup PAC ID 3577476258, 425 clinicians

Practice addresses (Care Compare)

1212 Spruce St
Suite 315
Belmont, NC 28012-3386
Phone (704) 865-3848

Hospital & facility affiliations

  • Caromont Regional Medical Center Hospital, Gastonia, NC, CCN 340032

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5014609NCMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Caldwell Memorial Hospital Inc. CurrentSince Aug 23, 2021 Accepting new patients
Caromont Medical Group Inc CurrentSince Feb 26, 2024 Accepting new patients
Caldwell Memorial Hospital, Inc Current Accepting new patients
Caldwell Memorial Hospital, Inc. CurrentSince Aug 23, 2021 Accepting new patients
Caromont Medical Group Inc Current Accepting new patients
Caromont Medical Group Inc CurrentSince Feb 26, 2024 Accepting new patients

Locations

1212 Spruce St
Belmont, NC 28012
Phone (704) 825-5677

1212 Spruce St
Ste 315
Belmont, NC 28012
Phone (704) 461-8253

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

1337 E Garrison Blvd
Gastonia, NC 28054
Phone (704) 671-5313

401 Mulberry St SW
Ste 102
Lenoir, NC 28645
Phone (828) 757-6434

407 Mulberry St SW
Lenoir, NC 28645
Phone (828) 394-6720

321 Mulberry St SW
Lenoir, NC 28645
Phone (828) 757-5100

Organizations & group practices 6

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 1

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": "1626307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707955200000",
    "number": "1164094454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 744786",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303744786",
            "telephone_number": "704-834-2450",
            "fax_number": "704-671-5331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1337 E GARRISON BLVD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280545127",
            "telephone_number": "704-865-3848",
            "fax_number": "704-854-3086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "CRYSTAL",
        "middle_name": "DAWN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-15",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NC",
            "license": "5014609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

Verify at the official NPI Registry.