Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN214083 | GA |
NPI | 1013458918 |
---|---|
Provider Name | Turquoise Allen |
First Address | Conyers, GA 30094-5173 |
Second Address | Conyers, GA 30094-5173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2017 |
Last Update Date | 08/04/2019 |