Provider Demographics
NPI:1336307339
Name:ALLEN, KIRK EMANUEL (LVN)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:EMANUEL
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 BUNKER HILL DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-2221
Mailing Address - Country:US
Mailing Address - Phone:254-598-0141
Mailing Address - Fax:254-598-0141
Practice Address - Street 1:2514 BUNKER HILL DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-2221
Practice Address - Country:US
Practice Address - Phone:254-598-0141
Practice Address - Fax:254-598-0141
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX157542164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001002933Medicaid