Kelly Elizabeth Young, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12011027A Issued in IN

Practice address

2005 Saint Charles St Ste 5
Jasper, IN 47546-9146

Phone

(812) 482-4321

Fax

(812) 634-6809

NPI assigned

Jul 2, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851598833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1219 RED DUNES RUN",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461239536",
            "telephone_number": "812-482-4321",
            "fax_number": "812-634-6809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 SAINT CHARLES ST STE 5",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475469146",
            "telephone_number": "812-482-4321",
            "fax_number": "812-634-6809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "KELLY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12011027A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "12011027A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael A Wohlberg, MD
• Kyley Alan Wood, D.D.S.
• Peggy Lynn Wood, CRNA
• Martha F Yearsley, M.D.
• Dana Young
• Stephanie Young, PTA
• Holly Zehr, M.D.
• Jessica Marie Zehr, F.N.P.
• Cassey W Ziegler, FNP-C

• General Practice Dentistry in Jasper, IN
• Providers in Jasper, IN by specialty
• General Practice Dentistry in Indiana

• 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.