MEDICARE: MRS. PAMELA 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	172A00000X	Driver

General Provider Information

NPI Number	:	1689252884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA ALLEN

Provider Business Mailing Address
First Line	:	PO BOX 1043
Second Line	:
City	:	MABELVALE
State	:	AR
Zip	:	72103-1043
Country	:	US
Telephone Number	:	501-442-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	5705 W 65TH ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-3827
Country	:	US
Telephone Number	:	501-442-3600
Fax Number	:

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

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	03/30/2021

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Directions to “ MRS. PAMELA ALLEN ” Practice Location

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