Provider Demographics
NPI:1891229944
Name:PROUTY, ALLISON JANE (NP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:JANE
Last Name:PROUTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:KEALING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1600 N BEAUREGARD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3440 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041
Practice Address - Country:US
Practice Address - Phone:703-717-7100
Practice Address - Fax:703-717-4149
Is Sole Proprietor?:No
Enumeration Date:2017-04-15
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001260546363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health