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NPI Code Detail

MEDICARE: JEANIE L ALLEN NURSE PRACTIONER

MEDICARE:   JEANIE L ALLEN  NURSE PRACTIONER
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
1363LA2200XAdult Health Nurse PractitionerRN087452GA
2363L00000XNurse PractitionerRN087452GA

General Provider Information

NPI Number : 1881705812
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANIE L ALLEN NURSE PRACTIONER
Provider Business Mailing Address
First Line : 101 HARRIS INDUSTRIAL BLVD STE A
Second Line :
City : VIDALIA
State : GA
Zip : 30474-8852
Country : US
Telephone Number : 912-535-3500
Fax Number : 912-535-4498
Provider Business Practice Location Address
First Line : 1006 MOUNT VERNON RD
Second Line :
City : VIDALIA
State : GA
Zip : 30474-3029
Country : US
Telephone Number : 912-537-1221
Fax Number : 912-537-1221
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 05/05/2021

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Directions to “ JEANIE L ALLEN NURSE PRACTIONER” Practice Location

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