Provider Demographics
NPI:1295319986
Name:ALLEN, MICHAEL YOUNG (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:YOUNG
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 OGLALA CT
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89433-6643
Mailing Address - Country:US
Mailing Address - Phone:775-530-1510
Mailing Address - Fax:
Practice Address - Street 1:5070 ION DR STE 100
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-1654
Practice Address - Country:US
Practice Address - Phone:775-770-7682
Practice Address - Fax:775-770-7755
Is Sole Proprietor?:No
Enumeration Date:2021-05-08
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2737363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program