Provider Demographics
NPI:1134308745
Name:ALLEN, JACQUELYN LEA (DO)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:LEA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7450 KESSLER ST
Mailing Address - Street 2:STE 300
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204
Mailing Address - Country:US
Mailing Address - Phone:913-632-2900
Mailing Address - Fax:913-632-2999
Practice Address - Street 1:7450 KESSLER ST
Practice Address - Street 2:STE 300
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204
Practice Address - Country:US
Practice Address - Phone:913-632-2900
Practice Address - Fax:913-632-2999
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2022-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2010009594207Q00000X
KS05-38982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine