John Wallace Young Jr., PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA00326 Issued in TX

Practice address

1103 Woodson Dr
Caldwell, TX 77836-1052

Phone

(979) 567-7080

Fax

(979) 567-9783

NPI assigned

Jun 29, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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

• St Joseph Physician Associates

  • Neurological Surgery Physician
  • Bryan, TX
  • NPI 1851405039

  Physician Assistant

  NPD (past)

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215965272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 714",
            "address_2": "3320 CR 377",
            "city": "CALDWELL",
            "state": "TX",
            "postal_code": "778360714",
            "telephone_number": "979-567-0185",
            "fax_number": "979-567-9783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 WOODSON DR",
            "city": "CALDWELL",
            "state": "TX",
            "postal_code": "778361052",
            "telephone_number": "979-567-7080",
            "fax_number": "979-567-9783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "JOHN",
        "middle_name": "WALLACE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA00326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Copperas Hollow, LLC (Caldwell Operator)
• John Maxwell Todd, OT
• Wal-Mart Stores Texas LLC (Walmart Pharmacy 10-0567)
• Karla Woods
• Christine Lynn Young
• Krista Zwernemann, PHARMD

• Physician Assistant in Caldwell, TX
• Providers in Caldwell, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.