MEDICARE: MARY JANE ALLEN MSN, APRN, BC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN0000006880	TN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00365538	OTHER	TN	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4148068	OTHER	TN	BCBS OF TENNESSEE

NPI Number	:	1841270972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JANE ALLEN MSN, APRN, BC

Provider Business Mailing Address
First Line	:	3150 LENOX PARK BLVD
Second Line	:	SUITE 214
City	:	MEMPHIS
State	:	TN
Zip	:	38115-4299
Country	:	US
Telephone Number	:	901-273-2368
Fax Number	:	901-273-2351

Provider Business Practice Location Address
First Line	:	3150 LENOX PARK BLVD
Second Line	:	SUITE 214
City	:	MEMPHIS
State	:	TN
Zip	:	38115-4299
Country	:	US
Telephone Number	:	901-273-2368
Fax Number	:	901-273-2351

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	10/29/2009

3150 LENOX PARK BLVD , STE 214
MEMPHIS, TN
38115-4299

Practice Phone: 901-273-2372
Practice Fax: 901-273-2351