Healthcare Provider Details

I. General information

NPI: 1144973975
Provider Name (Legal Business Name): AMY ALLEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY ALLEN CFNP

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 DEBUYS RD
BILOXI MS
39531-4402
US

IV. Provider business mailing address

9493 WOODROW PL
BILOXI MS
39532-8372
US

V. Phone/Fax

Practice location:
  • Phone: 228-388-0600
  • Fax:
Mailing address:
  • Phone: 228-865-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3-000674
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: