MEDICARE: MS. AURELIA ALLEN NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN121276	GA
2	363L00000X	Nurse Practitioner	4440	SC
3	363L00000X	Nurse Practitioner	95024684	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01088998	OTHER	SC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437130937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AURELIA ALLEN NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1650 ANDERSON MILL RD
Second Line	:	APARTMENT #1208
City	:	AUSTELL
State	:	GA
Zip	:	30106-1252
Country	:	US
Telephone Number	:	404-964-3145
Fax Number	:

Provider Business Practice Location Address
First Line	:	3364 BEYER BLVD
Second Line	:
City	:	SAN YSIDRO
State	:	CA
Zip	:	92173-1322
Country	:	US
Telephone Number	:	619-205-4585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	04/22/2024

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