MEDICARE: MARY JO 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	363L00000X	Nurse Practitioner	F03250549	TX

General Provider Information

NPI Number	:	1679369169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JO ALLEN

Provider Business Mailing Address
First Line	:	409 W LIBERTY AVE
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-5127
Country	:	US
Telephone Number	:	512-524-3437
Fax Number	:	512-524-3437

Provider Business Practice Location Address
First Line	:	409 W LIBERTY AVE
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-5127
Country	:	US
Telephone Number	:	512-524-3437
Fax Number	:	512-524-3437

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

Provider Enumeration Date	:	04/19/2025
Last Update Date	:	03/06/2026

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Directions to “ MARY JO ALLEN ” Practice Location

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