Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 2021037463 | MO |
NPI | 1497330559 |
---|---|
Provider Name | Tabitha Grace Allen |
First Address | Independence, MO 64055-2760 |
Second Address | Kansas City, MO 64111-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2021 |
Last Update Date | 13/10/2021 |