Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | SP013345 | PA |
NPI | 1033549605 |
---|---|
Provider Name | Kelly Allen |
First Address | Spartansburg, PA 16434-2448 |
Second Address | Warren, PA 16365-2201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2013 |
Last Update Date | 05/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SP013345 | CRNP (01) | PA |