Provider Demographics
NPI:1861644650
Name:ALLEN, DOROTHY E (PA)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:E
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 FORT SANDERS WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3355
Mailing Address - Country:US
Mailing Address - Phone:865-769-4500
Mailing Address - Fax:865-769-4501
Practice Address - Street 1:260 FORT SANDERS WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3355
Practice Address - Country:US
Practice Address - Phone:865-769-4500
Practice Address - Fax:865-769-4501
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1644363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1510456Medicaid
TNP01519180OtherRAILROAD MEDICARE
TN4213359OtherBLUECROSS BLUESHIELD
TN1510456Medicaid
TN4213359OtherBLUECROSS BLUESHIELD