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General NPI Number Information
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NPI Number | 1275832297
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Entity Type | Individual
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Provider Name | MICHELLE NAN ALLEN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/16/2011
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 1067 HIGHLAND COLONY PKWY SUITE G
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City | RIDGELAND
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State | MS
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Zip | 39157-8770
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Country | US
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Telephone | 601-707-3737
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Fax |
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Provider Business Mailing Address
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Address Line | 1067 HIGHLAND COLONY PKWY SUITE G
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City | RIDGELAND
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State | MS
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Zip | 39157-8770
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Country | US
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Telephone | 601-707-3737
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R870618
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License Number State | MS
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