Individual provider Active NPI

Brenda J. Young, PA-C

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1952409302
Registry record updated Dec 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-05280 Issued in NC
Practice address
17232 Lancaster Hwy Ste 102
Charlotte, NC 28277-2093
Phone
(704) 544-0050
NPI assigned
Sep 20, 2006
Last updated
Dec 14, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-05280 NC Primary

Addresses

Primary practice location

17232 Lancaster Hwy Ste 102
Charlotte, NC 28277-2093

Mailing address

17232 Lancaster Hwy Ste 102
Charlotte, NC 28277-2093
Phone (704) 544-0050

Other identifiers 1

IdentifierTypeStateIssuer
Q48904MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150414000624 NC Practitioner - Physician Assistant 7517997273

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
15141CAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Liberty Family Physicians CurrentSince Oct 16, 2015 Accepting new patients
American Current Care of North Carolina PC CurrentSince Mar 2, 2015 Accepting new patients

Locations

1928 Weddington Rd
Weddington, NC 28104
Phone (704) 844-0505

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9968/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1952409302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17232 LANCASTER HWY STE 102",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282772093",
            "telephone_number": "704-544-0050",
            "fax_number": "704-635-7418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17232 LANCASTER HWY STE 102",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282772093",
            "telephone_number": "704-544-0050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "BRENDA",
        "middle_name": "J.",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-05280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q48904",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.