MEDICARE: ELIZABETH CLARK ALLEN CFNP

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	R871440	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01198568	OTHER	MS	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184946170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH CLARK ALLEN CFNP

Provider Business Mailing Address
First Line	:	PO BOX 23666
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39225-3666
Country	:	US
Telephone Number	:	601-200-4749
Fax Number	:

Provider Business Practice Location Address
First Line	:	728 CLINTON PKWY STE B
Second Line	:
City	:	CLINTON
State	:	MS
Zip	:	39056-5227
Country	:	US
Telephone Number	:	601-200-4800
Fax Number	:	601-200-4805

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

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	09/15/2021

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