Provider Demographics
NPI:1487209433
Name:YOUNG, JESSICA DIANE (MSN,ARNP,AGACNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DIANE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSN,ARNP,AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 PRAIRIE ROSE PL
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:IA
Mailing Address - Zip Code:52333-9478
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 HIGHWAY 6 W
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-2209
Practice Address - Country:US
Practice Address - Phone:319-610-4015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAL154906363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1619419017Medicaid