Provider Demographics
NPI:1679356083
Name:PUTT, ALLISON (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:PUTT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:KOEHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16515 S 40TH ST STE 143
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0560
Mailing Address - Country:US
Mailing Address - Phone:480-331-6322
Mailing Address - Fax:
Practice Address - Street 1:16515 S 40TH ST STE 143
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0560
Practice Address - Country:US
Practice Address - Phone:480-331-6322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241569363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily