Provider Demographics
NPI:1891068631
Name:FARMER, ALLYN NOELLE (PA)
Entity Type:Individual
Prefix:
First Name:ALLYN
Middle Name:NOELLE
Last Name:FARMER
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:PO BOX 1000 DEPT 245
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-761-9030
Mailing Address - Fax:901-761-9591
Practice Address - Street 1:80 HUMPHREYS CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2352
Practice Address - Country:US
Practice Address - Phone:901-761-9030
Practice Address - Fax:901-761-9591
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA 814363A00000X
IN10001395A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000779998OtherANTHEM PROVIDER NUMBER
TN2555OtherTN MEDICAL LICENSE
ALPA 814OtherSTATE BOARD OF MEDICAL EXAMINERS
INM400075423Medicare PIN