Healthcare Provider Details

I. General information

NPI: 1841270972
Provider Name (Legal Business Name): MARY JANE ALLEN MSN, APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 LENOX PARK BLVD SUITE 214
MEMPHIS TN
38115-4299
US

IV. Provider business mailing address

3150 LENOX PARK BLVD SUITE 214
MEMPHIS TN
38115-4299
US

V. Phone/Fax

Practice location:
  • Phone: 901-273-2368
  • Fax: 901-273-2351
Mailing address:
  • Phone: 901-273-2368
  • Fax: 901-273-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN0000006880
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: