Maryissa Eileen Young

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

4704315186 Issued in MI

Practice address

1205 S Mission St Ste 4
Mt Pleasant, MI 48858-3939

Phone

(989) 400-4369

NPI assigned

Feb 15, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1707955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1447015714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3487 S LINDEN RD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485073025",
            "telephone_number": "866-498-3909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 S MISSION ST STE 4",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488583939",
            "telephone_number": "989-400-4369"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3487 S Linden Rd",
            "address_purpose": "LOCATION",
            "city": "Flint",
            "state": "MI",
            "postal_code": "485073025",
            "country_code": "US",
            "telephone_number": "866-498-3909",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "MARYISSA",
        "middle_name": "EILEEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-15",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704315186",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MI",
            "license": "4704315186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vicki Lee Yazzie, BA, LBSW, QMHP,QMRP,
• Abigail Yon
• Sarah A Yonder, M.D.
• Straum Erik Yorton, ATC
• Mark D Young, DPM
• Carrie Youssef, COTA
• Zachary Kanjuparamban MDPC
• Sarah Zajac
• Jeffrey Lee Zarr, O.D,
• Kristina Zemelis, BSW

• Pediatric Nurse Practitioner in Mt Pleasant, MI
• Providers in Mt Pleasant, MI by specialty
• Pediatric Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; 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.