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General NPI Number Information
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NPI Number | 1083066591
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Entity Type | Individual
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Provider Name | ALLISON DREW DEZARN APRN
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Gender | Female
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Dates
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Enumeration Date | 07/08/2016
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 279 E MAIN ST
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City | HAZARD
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State | KY
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Zip | 41701-1973
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Country | US
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Telephone | 606-487-9505
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Fax | 606-436-0711
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Provider Business Mailing Address
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Address Line | 279 E MAIN ST
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City | HAZARD
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State | KY
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Zip | 41701-1973
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Country | US
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Telephone | 606-487-9505
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Fax | 606-436-0711
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3010409
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 3010409
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License Number State | KY
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