Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN290894 | GA |
N | 363LG0600X | Nurse Practitioner - Gerontology | AP130778 | TX |
NPI | 1053767210 |
---|---|
Provider Name | Lindsey Ann Allen |
First Address | Canton, GA 30114-6565 |
Second Address | Atlanta, GA 30322-1013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2016 |
Last Update Date | 26/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
359708001 | (05) | TX |