Individual
MRS. KEISHA MARIE YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
604 PIERCE BLVD STE 150, O FALLON, IL 62269-2588
(618) 222-9244
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209017366
IL
363LF0000X
Family Nurse Practitioner
2018005309
MO
Other
Enumeration date
05/31/2018
Last updated
07/10/2023
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