Provider Demographics
NPI:1093858201
Name:ALLEN, KYMBERLY RHEA (FNP)
Entity Type:Individual
Prefix:MS
First Name:KYMBERLY
Middle Name:RHEA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 W ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-2820
Mailing Address - Country:US
Mailing Address - Phone:704-296-4800
Mailing Address - Fax:704-296-4887
Practice Address - Street 1:1224 W ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2820
Practice Address - Country:US
Practice Address - Phone:704-296-4800
Practice Address - Fax:704-296-4887
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC182307163W00000X
NC118572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004310Medicaid
SCNP1273Medicaid