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General NPI Number Information
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NPI Number | 1851848683
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Entity Type | Individual
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Provider Name | STEPHANIE SLACK ALLEN DNP, APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 408 VIRGINIA ST
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City | PARIS
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State | TN
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Zip | 38242-5341
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Country | US
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Telephone | 731-642-0521
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Fax |
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Provider Business Mailing Address
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Address Line | 101 ALBERTA ST
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City | MARTIN
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State | TN
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Zip | 38237-3501
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Country | US
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Telephone | 731-514-5774
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 21694
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License Number State | TN
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