Healthcare Provider Details

I. General information

NPI: 1023345667
Provider Name (Legal Business Name): KEVIN ALEN AP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. DENNIS W ALLEN

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 A1A S STE 104
ST AUGUSTINE FL
32080-6523
US

IV. Provider business mailing address

6 PALM ROW
ST AUGUSTINE FL
32084-4409
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-9439
  • Fax:
Mailing address:
  • Phone: 904-824-9439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number00284
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: