Healthcare Provider Details

I. General information

NPI: 1568910164
Provider Name (Legal Business Name): HEATHER ALLEN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 SHARP AND PERKINS RD
JACKSBORO TN
37757-2507
US

IV. Provider business mailing address

151 ISLAND RD
JACKSBORO TN
37757-2904
US

V. Phone/Fax

Practice location:
  • Phone: 423-562-8351
  • Fax:
Mailing address:
  • Phone: 423-871-0902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number204859
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: