MEDICARE: KAITLYN ALLEN

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	363A00000X	Physician Assistant	085011792	IL

General Provider Information

NPI Number	:	1376404095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN ALLEN

Provider Business Mailing Address
First Line	:	1835 GENTRY WOODS CT
Second Line	:
City	:	DANVILLE
State	:	IN
Zip	:	46122-7500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 GENTRY WOODS CT
Second Line	:
City	:	DANVILLE
State	:	IN
Zip	:	46122-7500
Country	:	US
Telephone Number	:	317-993-7283
Fax Number	:

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

Provider Enumeration Date	:	11/21/2025
Last Update Date	:	11/21/2025

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Directions to “ KAITLYN ALLEN ” Practice Location

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