Provider Demographics
NPI: | 1518973064 |
---|---|
Name: | ALLEN, JOYCE ANN (APRN-FNP) |
Entity Type: | Individual |
Prefix: | |
First Name: | JOYCE |
Middle Name: | ANN |
Last Name: | ALLEN |
Suffix: | |
Gender: | F |
Credentials: | APRN-FNP |
Other - Prefix: | |
Other - First Name: | JOYCE |
Other - Middle Name: | ANN |
Other - Last Name: | SHEPHERD |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | ALLEN |
Mailing Address - Street 1: | 444 LEWIS DR |
Mailing Address - Street 2: | |
Mailing Address - City: | RICHMOND |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40475-7723 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 859-583-9275 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1306 VERSAILLES RD |
Practice Address - Street 2: | STE 120 |
Practice Address - City: | LEXINGTON |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40504-1796 |
Practice Address - Country: | US |
Practice Address - Phone: | 859-259-2635 |
Practice Address - Fax: | 859-254-7974 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-01 |
Last Update Date: | 2016-04-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 3003869 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 78008612 | Medicaid | |
KY | 3003869 | Other | APRN LICENSE NUMBER |
KY | 3869P | Other | ARNP |
KY | K096840 | Medicare PIN | |
KY | 78008612 | Medicaid |