Provider Demographics
NPI:1083072623
Name:SEAL, ALLEN RYAN (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:RYAN
Last Name:SEAL
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-2025
Mailing Address - Country:US
Mailing Address - Phone:985-748-9485
Mailing Address - Fax:
Practice Address - Street 1:301 WALNUT ST
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2025
Practice Address - Country:US
Practice Address - Phone:985-748-9485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP08682363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily