Healthcare Provider Details

I. General information

NPI: 1942752407
Provider Name (Legal Business Name): TANISHA RAION ALLEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANISHA ALLEN PATILLO

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA PL
MINDEN LA
71055-3330
US

IV. Provider business mailing address

200 CORPORATE BLVD
LAFAYETTE LA
70508-3870
US

V. Phone/Fax

Practice location:
  • Phone: 318-377-2321
  • Fax: 318-371-5606
Mailing address:
  • Phone: 800-893-9698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN127133
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09068
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: