Healthcare Provider Details

I. General information

NPI: 1801448006
Provider Name (Legal Business Name): KAREN LEE ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 OLD HIGHWAY 70 W
DIERKS AR
71833-8828
US

IV. Provider business mailing address

508 N 2ND ST
NASHVILLE AR
71852-3925
US

V. Phone/Fax

Practice location:
  • Phone: 870-286-3234
  • Fax:
Mailing address:
  • Phone: 870-455-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: