Provider Demographics
NPI:1164751335
Name:ABEL, ALLANNA R (RD)
Entity Type:Individual
Prefix:
First Name:ALLANNA
Middle Name:R
Last Name:ABEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ALLANNA
Other - Middle Name:R
Other - Last Name:COCKERILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8941
Mailing Address - Fax:765-935-8578
Practice Address - Street 1:1050 REID PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1155
Practice Address - Country:US
Practice Address - Phone:765-935-8941
Practice Address - Fax:765-935-8578
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001982A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000943467OtherANTHEM
INOPRMedicaid
OH0140546Medicaid
INOPRMedicaid