Active NPI
Amanda R Young
- Student in an Organized Health Care Education/Training Program
- McKinleyville, CA
National Provider Identifier
1194399253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1560 Betty CT
McKinleyville, CA 95519-4405 - Phone
- (707) 298-1556
- NPI assigned
- May 13, 2021
- Reactivated
- Jun 16, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
1560 Betty CT
McKinleyville, CA 95519-4405
Mailing address
1560 Betty CT
McKinleyville, CA 95519-4405
Phone (707) 298-1556
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674691200000",
"number": "1194399253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1560 BETTY CT",
"city": "MCKINLEYVILLE",
"state": "CA",
"postal_code": "955194405",
"telephone_number": "707-298-1556"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1560 BETTY CT",
"city": "MCKINLEYVILLE",
"state": "CA",
"postal_code": "955194405",
"telephone_number": "707-298-1556"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "AMANDA",
"middle_name": "R",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-13",
"last_updated": "2023-01-26",
"certification_date": "2021-06-29",
"deactivation_date": "2021-05-25",
"reactivation_date": "2021-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McKinleyville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.