MEDICARE: CASSIE ELIZABETH ALLEN

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1689155905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIE ELIZABETH ALLEN

Provider Business Mailing Address
First Line	:	3337 OVERBROOK DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-3351
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3337 OVERBROOK DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-3351
Country	:	US
Telephone Number	:	859-285-9156
Fax Number	:

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

Provider Enumeration Date	:	08/24/2018
Last Update Date	:	08/24/2018

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