Healthcare Provider Details

I. General information

NPI: 1093641854
Provider Name (Legal Business Name): JOA G ALLEN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SEYMOUR RD
UTICA NY
13502-1311
US

IV. Provider business mailing address

PO BOX 22
KEENE NY
12942-0022
US

V. Phone/Fax

Practice location:
  • Phone: 518-578-6335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number359909
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: