Provider Demographics
NPI:1073955142
Name:ALLEN, TINA B (MAED-IECE)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:B
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MAED-IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 PAYNEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-8601
Mailing Address - Country:US
Mailing Address - Phone:270-668-2698
Mailing Address - Fax:
Practice Address - Street 1:2125 PAYNEVILLE RD
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-8601
Practice Address - Country:US
Practice Address - Phone:270-668-2698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY201104789171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor