Active NPI
Kassidy Youngblood, LAC
- Counselor
- Searcy, AR
National Provider Identifier
1598396103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- A2002019
- Practice address
- 1507 E. Race Ave.
Searcy, AR 72143-4661 - Phone
- (501) 305-2359
- Fax
- (501) 305-2348
- NPI assigned
- Feb 1, 2020
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | A2002019 | AR | Primary |
Addresses
Primary practice location
1507 E. Race Ave.
Searcy, AR 72143-4661
Mailing address
1815 Pleasant Grove Road
Jonesboro, AR 72405-7870
Phone (870) 933-6886
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 |
|---|---|---|---|
| A2002019 | AR | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640217600000",
"number": "1598396103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1815 PLEASANT GROVE ROAD",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724057870",
"telephone_number": "870-933-6886",
"fax_number": "870-933-9395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1507 E. RACE AVE.",
"city": "SEARCY",
"state": "AR",
"postal_code": "721434661",
"telephone_number": "501-305-2359",
"fax_number": "501-305-2348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNGBLOOD",
"first_name": "KASSIDY",
"credential": "LAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-01",
"last_updated": "2021-12-23",
"certification_date": "2021-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "AR",
"license": "A2002019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Searcy, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.