Provider Demographics
NPI:1598956211
Name:ALLEN, PATRICIA R (CWHNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CWHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4499 MEDICAL DR
Mailing Address - Street 2:STE 191
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3735
Mailing Address - Country:US
Mailing Address - Phone:210-692-0831
Mailing Address - Fax:210-692-9202
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:STE 191
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3735
Practice Address - Country:US
Practice Address - Phone:210-692-0831
Practice Address - Fax:210-692-9202
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP114255363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN815510LLLMedicare PIN
IN815520VVVVMedicare PIN
IN000000533781OtherANTHEM PROVIDER NUMBER
INP00782465Medicare PIN
INQ42953Medicare UPIN
IN224390KKMedicare PIN
IN815460OOOOMedicare PIN
IN815500H10Medicare PIN
IN200876500Medicaid