MEDICARE: MR. KENNETH J ALLEN RN

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	163WH0200X	Home Health Registered Nurse	3599	AL

General Provider Information

NPI Number	:	1891003380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH J ALLEN RN

Provider Business Mailing Address
First Line	:	2277 BUFFINGTON RD.
Second Line	:
City	:	BOAZ
State	:	AL
Zip	:	35956
Country	:	US
Telephone Number	:	256-840-6352
Fax Number	:

Provider Business Practice Location Address
First Line	:	2277 BUFFINGTON RD.
Second Line	:
City	:	BOAZ
State	:	AL
Zip	:	35956
Country	:	US
Telephone Number	:	256-840-6352
Fax Number	:

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

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	09/17/2010

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