Healthcare Provider Details

I. General information

NPI: 1457322778
Provider Name (Legal Business Name): PATRICIA LOUISE ALLEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 FRIZZELL ST SUITE 5
POTOSI MO
63664-1505
US

IV. Provider business mailing address

200 HEALTH WAY DR
POTOSI MO
63664-1434
US

V. Phone/Fax

Practice location:
  • Phone: 573-438-8500
  • Fax: 573-438-8787
Mailing address:
  • Phone: 573-438-8500
  • Fax: 573-438-8787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number143173
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: