Provider Demographics
NPI:1790870194
Name:ALLEN, AUDREY KAY (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:KAY
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 THOMPSON LN STE 30330
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-4701
Mailing Address - Country:US
Mailing Address - Phone:615-936-2000
Mailing Address - Fax:615-936-0605
Practice Address - Street 1:1717 HIGH ST STE 1A
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-6300
Practice Address - Country:US
Practice Address - Phone:270-885-0570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704219757363LA2200X, 363LP2300X
TN20725363LA2200X
KY0385214363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ025810Medicaid
MI4845185Medicaid
MI4845185Medicaid