Provider Demographics
NPI:1609590967
Name:ALLEN, MADISON BROOKE (KPSS)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:BROOKE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:KPSS
Other - Prefix:
Other - First Name:MADIOSN
Other - Middle Name:BROOKE
Other - Last Name:WARDRIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KPSS
Mailing Address - Street 1:449 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:KY
Mailing Address - Zip Code:42539-7569
Mailing Address - Country:US
Mailing Address - Phone:606-706-7894
Mailing Address - Fax:
Practice Address - Street 1:106 BELINDA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-3217
Practice Address - Country:US
Practice Address - Phone:859-439-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist