Active NPI
Nicole Kaleen Young, PA-C
- Physician Assistant
- Vallejo, CA
National Provider Identifier
1760912117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 54665
- Practice address
- 100 Hospital Dr Ste 303
Vallejo, CA 94589-2583 - Phone
- (707) 645-7210
- NPI assigned
- Jun 19, 2017
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 54665 | CA | Primary |
Addresses
Primary practice location
100 Hospital Dr Ste 303
Vallejo, CA 94589-2583
Mailing address
199 Polaris CT
Vallejo, CA 94591-6943
Phone (707) 334-2615
Other practice location 1
2755 Herndon Ave
Clovis, CA 93611-6800
Phone (559) 324-4000
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54665 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552435200000",
"number": "1760912117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "199 POLARIS CT",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945916943",
"telephone_number": "707-334-2615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 HOSPITAL DR STE 303",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945892583",
"telephone_number": "707-645-7210"
}
],
"practiceLocations": [
{
"address_1": "2755 Herndon Ave",
"address_purpose": "LOCATION",
"city": "Clovis",
"state": "CA",
"postal_code": "936116800",
"country_code": "US",
"telephone_number": "559-324-4000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "YOUNG",
"first_name": "NICOLE",
"middle_name": "KALEEN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-19",
"last_updated": "2019-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "54665",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.