Healthcare Provider Details

I. General information

NPI: 1649615337
Provider Name (Legal Business Name): KRISTA M ALLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MARION PIKE
COAL GROVE OH
45638-3165
US

IV. Provider business mailing address

2585 3RD AVE
HUNTINGTON WV
25703-1642
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-1188
  • Fax: 740-532-1183
Mailing address:
  • Phone: 304-697-1396
  • Fax: 304-697-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49135
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.139519
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: