Provider Demographics
NPI:1033319686
Name:ALLEN, KATTIE J (MD)
Entity Type:Individual
Prefix:
First Name:KATTIE
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 SE PLAZA AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-5697
Mailing Address - Country:US
Mailing Address - Phone:479-273-3376
Mailing Address - Fax:479-273-3468
Practice Address - Street 1:901 SE PLAZA AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-5697
Practice Address - Country:US
Practice Address - Phone:479-273-3376
Practice Address - Fax:479-273-3468
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE7618207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00665857OtherRAILROAD MEDICARE
MN070000804Medicare PIN