Provider Demographics
NPI:1891003380
Name:ALLEN, KENNETH J (RN)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:J
Last Name:ALLEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2277 BUFFINGTON RD.
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35956
Mailing Address - Country:US
Mailing Address - Phone:256-840-6352
Mailing Address - Fax:
Practice Address - Street 1:2277 BUFFINGTON RD.
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35956
Practice Address - Country:US
Practice Address - Phone:256-840-6352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3599163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health