Provider Demographics
NPI:1114154614
Name:ALLEN, KEITH R (RN)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 PETERS LN
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-1407
Mailing Address - Country:US
Mailing Address - Phone:631-288-9512
Mailing Address - Fax:
Practice Address - Street 1:79 PETERS LN
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-1407
Practice Address - Country:US
Practice Address - Phone:631-288-9512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY499468163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine