Provider Demographics
NPI:1518018688
Name:ALLRED, JOLENA B (FNP)
Entity Type:Individual
Prefix:MS
First Name:JOLENA
Middle Name:B
Last Name:ALLRED
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JOLENA
Other - Middle Name:A
Other - Last Name:KINGREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 17990
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4074
Mailing Address - Country:US
Mailing Address - Phone:910-428-1544
Mailing Address - Fax:910-428-4567
Practice Address - Street 1:104 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:BISCOE
Practice Address - State:NC
Practice Address - Zip Code:27209-9835
Practice Address - Country:US
Practice Address - Phone:910-428-1544
Practice Address - Fax:910-428-1567
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S01783Medicare UPIN