Provider Demographics
NPI:1114994035
Name:ALLEN, KRISTI RENEE (ANP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:RENEE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LEPANTO
Mailing Address - State:AR
Mailing Address - Zip Code:72354-2200
Mailing Address - Country:US
Mailing Address - Phone:870-475-2977
Mailing Address - Fax:870-475-3440
Practice Address - Street 1:102 W BROAD ST
Practice Address - Street 2:
Practice Address - City:LEPANTO
Practice Address - State:AR
Practice Address - Zip Code:72354-2200
Practice Address - Country:US
Practice Address - Phone:870-475-2977
Practice Address - Fax:870-475-3440
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01254363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135451758Medicaid