Provider Demographics
NPI:1437130937
Name:ALLEN, AURELIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:AURELIA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 ANDERSON MILL RD
Mailing Address - Street 2:APARTMENT #1208
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1252
Mailing Address - Country:US
Mailing Address - Phone:404-964-3145
Mailing Address - Fax:
Practice Address - Street 1:3364 BEYER BLVD
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-1322
Practice Address - Country:US
Practice Address - Phone:619-205-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN121276363LF0000X
SC4440363L00000X
CA95024684363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01088998OtherRAILROAD MEDICARE
SCNP2048Medicaid
SCNP2048Medicaid