Healthcare Provider Details

I. General information

NPI: 1750800272
Provider Name (Legal Business Name): KIMBERLY MARIE ALLEN APRN- FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 12/10/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 E US HIGHWAY 136
ALBANY MO
64402-8223
US

IV. Provider business mailing address

1607 E US HIGHWAY 136
ALBANY MO
64402-8223
US

V. Phone/Fax

Practice location:
  • Phone: 660-726-3333
  • Fax: 660-726-3232
Mailing address:
  • Phone: 660-726-3333
  • Fax: 660-726-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017032207
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: