Healthcare Provider Details

I. General information

NPI: 1275979965
Provider Name (Legal Business Name): JACQUELINE MICHELLE ALLEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TULANE AVE # 8016
NEW ORLEANS LA
70112-2632
US

IV. Provider business mailing address

200 MERCY CIR
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-9963
  • Fax: 504-988-8252
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.062901
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number352671
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.141180
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA144496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: