MEDICARE: MRS. TONYA RENEA ALLEN APRN, NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	A003803	AR

General Provider Information

NPI Number	:	1013255298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TONYA RENEA ALLEN APRN, NP-C

Provider Business Mailing Address
First Line	:	4815 W MARKHAM ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-3866
Country	:	US
Telephone Number	:	501-661-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3112 S 70TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5068
Country	:	US
Telephone Number	:	479-452-8600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2013
Last Update Date	:	07/23/2014

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