Individual
KELLY THOMAS YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
14000 FAIRVIEW DR, BURNSVILLE, MN 55337-4571
(952) 993-8700
(952) 993-8516
Mailing address
8170 33RD AVE S, MS 21110Q, BLOOMINGTON, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2326
MN
363LF0000X
Family Nurse Practitioner
CNP2326
MN
363LF0000X
Family Nurse Practitioner
R 168856-0
MN
Other
Enumeration date
05/12/2014
Last updated
08/27/2021
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