Active NPI
Tiffany Young
- Prosthetics Case Management
- Wentzville, MO
National Provider Identifier
1194336768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetics Case Management
- License
- 2004007868
- Practice address
- 411 E Pearce Blvd
Wentzville, MO 63385-1533 - Phone
- (636) 281-8433
- NPI assigned
- Aug 16, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetics Case Management | 1744P3200X | 2004007868 | MO | Primary |
Addresses
Primary practice location
411 E Pearce Blvd
Wentzville, MO 63385-1533
Mailing address
411 E Pearce Blvd
Wentzville, MO 63385-1533
Phone (636) 281-8433
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2004007868 | Other | MO | SPECIALIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004007868 | MO | MD | Prosthetics Case Management |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597536000000",
"number": "1194336768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 E PEARCE BLVD",
"city": "WENTZVILLE",
"state": "MO",
"postal_code": "633851533",
"telephone_number": "636-281-8433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 E PEARCE BLVD",
"city": "WENTZVILLE",
"state": "MO",
"postal_code": "633851533",
"telephone_number": "636-281-8433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "TIFFANY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-16",
"last_updated": "2020-08-16",
"certification_date": "2020-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "1744P3200X",
"taxonomy_group": "",
"desc": "Specialist, Prosthetics Case Management",
"state": "MO",
"license": "2004007868",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPECIALIST",
"identifier": "2004007868",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wentzville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.