Provider Demographics
NPI:1346592268
Name:ALLEN, CARISSA MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:MICHELLE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66840 BELMONT MORRISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43718-9665
Mailing Address - Country:US
Mailing Address - Phone:740-782-1031
Mailing Address - Fax:
Practice Address - Street 1:66840 BELMONT MORRISTOWN RD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:OH
Practice Address - Zip Code:43718-9665
Practice Address - Country:US
Practice Address - Phone:740-782-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003567363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant