Healthcare Provider Details

I. General information

NPI: 1053224931
Provider Name (Legal Business Name): SHANNON DALE ALLEN MSN, APRN, AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 S 3RD ST
DANVILLE KY
40422-1823
US

IV. Provider business mailing address

PO BOX 1034
LIBERTY KY
42539-1034
US

V. Phone/Fax

Practice location:
  • Phone: 859-239-1000
  • Fax:
Mailing address:
  • Phone: 606-706-0610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3016565
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: