Individual
MR. KELLY LYNN YOUNGERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
110 NNPTC CIR, GOOSE CREEK, SC 29445-6314
(843) 794-6228
Mailing address
110 NNPTC CIR, GOOSE CREEK, SC 29445-6314
(843) 794-6152
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
10/19/2006
Last updated
12/15/2016
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