Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | P1392 | TN |
NPI | 1184753311 |
---|---|
Provider Name | Ronald Lynn Allen |
First Address | Knoxville, TN 37923-4404 |
Second Address | Knoxville, TN 37923-4404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2005918 | BLUE CROSS BLUE SHIELD (01) | TN |
3680005 | (05) | TN |
P1392 | PSYCHOLOGIST LICENSE (01) | TN |