Shannon R Young, APRN

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

3007710 Issued in KY

Practice address

404 Steve Drive
Russell Springs, KY 42642-4622

Phone

(270) 866-3161

Fax

(270) 866-3163

NPI assigned

Oct 15, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Jamestown Healthcare Clinic LLC

  • Family Medicine Physician
  • Jamestown, KY
  • NPI 1588723241
  NPD
• Cumberland Family Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Danville, KY
  • NPI 1215918917
  NPD (past)

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

{
    "created_epoch": "1350259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688342400000",
    "number": "1184976151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1080",
            "city": "BURKESVILLE",
            "state": "KY",
            "postal_code": "427171080",
            "telephone_number": "270-864-1472",
            "fax_number": "270-864-1693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 STEVE DRIVE",
            "city": "RUSSELL SPRINGS",
            "state": "KY",
            "postal_code": "426424622",
            "telephone_number": "270-866-3161",
            "fax_number": "270-866-3163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "SHANNON",
        "middle_name": "R",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-15",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "KY",
            "license": "3007710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY APRN LICENSE",
            "identifier": "3007710",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100242840",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsey Smith Wilson, PHARMD
• Whitnie Wolsey, BCBA, LBA
• Women Finding Freedom Thru Recovery LLC
• Dawn Andrea Woodroof, MD
• Charlton Wooldridge, BSW, CSA, APSS

• All providers in Russell Springs, KY
• Pediatric Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2023; 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.