Provider Demographics
NPI:1669680922
Name:ALLEN, AUDREY ANN (PA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ANN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:ANN
Other - Last Name:BROUSHET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2105 W SPRING CREEK PKWY STE A300
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-4195
Mailing Address - Country:US
Mailing Address - Phone:972-208-2900
Mailing Address - Fax:972-491-6750
Practice Address - Street 1:2105 W SPRING CREEK PKWY STE A300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4195
Practice Address - Country:US
Practice Address - Phone:972-208-2900
Practice Address - Fax:972-491-6750
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04418363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX430674YKP5Medicare PIN