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NPI Code Detail

MEDICARE: JEFFREY ALLEN PA

MEDICARE: JEFFREY ALLEN PA
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
1363A00000XPhysician Assistant1823WV
2363A00000XPhysician Assistant0010-11349NC

General Provider Information

NPI Number : 1295134955
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY ALLEN PA
Provider Business Mailing Address
First Line : PO BOX 601843
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-1843
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8450 PARK RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-5801
Country : US
Telephone Number : 980-308-0143
Fax Number : 980-308-0142
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2014
Last Update Date : 02/01/2022

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Directions to “ JEFFREY ALLEN PA” Practice Location

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