Healthcare Provider Details

I. General information

NPI: 1275572935
Provider Name (Legal Business Name): KATHLEEN ANN ALLEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ANN GULDAN

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 BLAKE BLVD 219
PINEHURST NC
28370-0345
US

IV. Provider business mailing address

PO BOX 219
PINEHURST NC
28370-0219
US

V. Phone/Fax

Practice location:
  • Phone: 910-639-7053
  • Fax:
Mailing address:
  • Phone: 910-295-4254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number200844
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number063311
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200854
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: