MEDICARE: THRESIA J ALLEN RN, 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	363L00000X	Nurse Practitioner	576947	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1245422203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THRESIA J ALLEN RN, NP-C

Provider Business Mailing Address
First Line	:	1392 W US HIGHWAY 290
Second Line	:	UNIT 2
City	:	ELGIN
State	:	TX
Zip	:	78621
Country	:	US
Telephone Number	:	512-285-3315
Fax Number	:	512-281-2872

Provider Business Practice Location Address
First Line	:	1392 W US HIGHWAY 290
Second Line	:	UNIT 2
City	:	ELGIN
State	:	TX
Zip	:	78621
Country	:	US
Telephone Number	:	512-285-3315
Fax Number	:	512-281-2872

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

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	10/24/2022

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