=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316765134
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TEYANNA ALLEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2024
-----------------------------------------------------
Last Update Date | 10/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10001 LAKE FOREST BLVD
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70127-6200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-276-4072
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10001 LAKE FOREST BLVD
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70127-6200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-276-4072
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 211D00000X
-----------------------------------------------------
Taxonomy Name | Podiatric Assistant
-----------------------------------------------------
License Number | L1201910311
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number | L1201910311
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------