Provider Demographics
NPI:1629110895
Name:ALLYN, JOCELYN A (FNPC)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:A
Last Name:ALLYN
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-1206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1023 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6780
Practice Address - Country:US
Practice Address - Phone:334-418-6656
Practice Address - Fax:334-418-6657
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003027280364SF0001X, 363LF0000X
AL1-149809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO186350OtherMO BLUE SHIELD
MO428402101Medicaid
AR82738OtherARK BLUE SHIELD
AR157481758Medicaid
MO428402101Medicaid
MO819003268Medicare PIN