Healthcare Provider Details

I. General information

NPI: 1669952644
Provider Name (Legal Business Name): BOBBIE JEAN ALLEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BOBBIE JEAN MCKINNEY

II. Dates (important events)

Enumeration Date: 08/18/2018
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 RICHMOND RD
IRVINE KY
40336-7231
US

IV. Provider business mailing address

1100 RICHMOND RD
IRVINE KY
40336-7231
US

V. Phone/Fax

Practice location:
  • Phone: 606-723-7747
  • Fax: 606-726-9410
Mailing address:
  • Phone: 606-723-7771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1138870
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3012600
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: