Healthcare Provider Details

I. General information

NPI: 1952721102
Provider Name (Legal Business Name): JESSICA RIVERS ALLEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 06/21/2020
Certification Date: 06/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 PAGE RD STE 101
DURHAM NC
27703-7724
US

IV. Provider business mailing address

2232 PAGE RD STE 101
DURHAM NC
27703-7724
US

V. Phone/Fax

Practice location:
  • Phone: 919-849-8617
  • Fax: 234-666-3073
Mailing address:
  • Phone: 919-937-9831
  • Fax: 234-666-3073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number202000048
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number202000048
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: