Provider Demographics
NPI:1619470010
Name:ALLEN, TAYLOR ELIZABETH CLINE (APRN)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ELIZABETH CLINE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 WILLIAM LILE RD
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:KY
Mailing Address - Zip Code:42217-8128
Mailing Address - Country:US
Mailing Address - Phone:270-881-2476
Mailing Address - Fax:
Practice Address - Street 1:375 WILLIAM LILE RD
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:KY
Practice Address - Zip Code:42217-8128
Practice Address - Country:US
Practice Address - Phone:270-881-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3011825OtherAPRN LICENSE