Provider Demographics
NPI:1417937558
Name:ALLEN, ANTHONY S (PAC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:S
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 N ROOP ST STE 112
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-3107
Mailing Address - Country:US
Mailing Address - Phone:775-883-7938
Mailing Address - Fax:775-883-0907
Practice Address - Street 1:755 N ROOP ST STE 112
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-3107
Practice Address - Country:US
Practice Address - Phone:775-883-7938
Practice Address - Fax:775-883-0907
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA386363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002416066Medicaid
NVP55753Medicare UPIN
NVV103512Medicare PIN