Provider Demographics
NPI:1316210578
Name:ALLENSWORTH, PATTI LYNN
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:LYNN
Last Name:ALLENSWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 2230
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-9716
Mailing Address - Country:US
Mailing Address - Phone:580-271-0994
Mailing Address - Fax:580-298-1199
Practice Address - Street 1:RR 2 BOX 2230
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-9716
Practice Address - Country:US
Practice Address - Phone:580-271-0994
Practice Address - Fax:580-298-1199
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator