Provider Demographics
NPI:1023503554
Name:YOUNG, GRENISHA L (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:GRENISHA
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 GREENSBORO DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-4700
Mailing Address - Country:US
Mailing Address - Phone:601-334-0113
Mailing Address - Fax:
Practice Address - Street 1:2941 TERRY RD STE 6
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-3071
Practice Address - Country:US
Practice Address - Phone:601-363-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily