Healthcare Provider Details

I. General information

NPI: 1881908366
Provider Name (Legal Business Name): NATHAN KENT ALLEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 ADDISON AVE E SUITE B
TWIN FALLS ID
83301-6749
US

IV. Provider business mailing address

PO BOX 587
TWIN FALLS ID
83303-0587
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-7700
  • Fax: 208-933-9301
Mailing address:
  • Phone: 208-814-7400
  • Fax: 208-814-7496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO-0737
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: