MEDICARE: ALLISON FANNIN

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	363LP2300X	Primary Care Nurse Practitioner	4046000	KY

General Provider Information

NPI Number	:	1194668111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON FANNIN

Provider Business Mailing Address
First Line	:	909 LILY DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3204
Country	:	US
Telephone Number	:	859-334-0484
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 W LOWRY LN STE 132
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-3006
Country	:	US
Telephone Number	:	859-334-0484
Fax Number	:

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “ ALLISON FANNIN ” Practice Location

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