Provider Demographics
NPI:1245422203
Name:ALLEN, THRESIA J (RN, NP-C)
Entity Type:Individual
Prefix:
First Name:THRESIA
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RN, NP-C
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Other - First Name:
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Mailing Address - Street 1:1392 W US HIGHWAY 290
Mailing Address - Street 2:UNIT 2
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621
Mailing Address - Country:US
Mailing Address - Phone:512-285-3315
Mailing Address - Fax:512-281-2872
Practice Address - Street 1:1392 W US HIGHWAY 290
Practice Address - Street 2:UNIT 2
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621
Practice Address - Country:US
Practice Address - Phone:512-285-3315
Practice Address - Fax:512-281-2872
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2022-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX576947363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189029502Medicaid
TX189029501Medicaid
TX189029502Medicaid
TX8K1118Medicare PIN
TXP01022964Medicare PIN