MEDICARE: JESSICA RIVERS ALLEN M.D.

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	2084P0802X	Addiction Psychiatry Physician	202000048	NC
2	2084P0800X	Psychiatry Physician	202000048	NC

General Provider Information

NPI Number	:	1952721102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RIVERS ALLEN M.D.

Provider Business Mailing Address
First Line	:	2232 PAGE RD STE 101
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-7724
Country	:	US
Telephone Number	:	919-937-9831
Fax Number	:	234-666-3073

Provider Business Practice Location Address
First Line	:	2232 PAGE RD STE 101
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-7724
Country	:	US
Telephone Number	:	919-849-8617
Fax Number	:	234-666-3073

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

Provider Enumeration Date	:	04/25/2014
Last Update Date	:	06/21/2020

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