Healthcare Provider Details

I. General information

NPI: 1578229928
Provider Name (Legal Business Name): KYLE STEVEN ALLEN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 CHASTAIN RD NW
KENNESAW GA
30144-3012
US

IV. Provider business mailing address

270 CHASTAIN RD NW
KENNESAW GA
30144-3012
US

V. Phone/Fax

Practice location:
  • Phone: 770-421-8005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP269501
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: