Provider Demographics
NPI:1669842498
Name:ALLEN, ASHLEY R (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12148 LUFTBURROW LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34669-5005
Mailing Address - Country:US
Mailing Address - Phone:580-478-9601
Mailing Address - Fax:208-502-2570
Practice Address - Street 1:500 W FORT ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4599
Practice Address - Country:US
Practice Address - Phone:208-391-0787
Practice Address - Fax:208-502-2570
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103435363LF0000X
ID67008363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily