Provider Demographics
NPI:1891878609
Name:ALLEN, STEPHEN CHARLES (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CHARLES
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 MESA DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8552
Mailing Address - Country:US
Mailing Address - Phone:509-627-1051
Mailing Address - Fax:
Practice Address - Street 1:948 STEVENS DR
Practice Address - Street 2:SUITE C
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3547
Practice Address - Country:US
Practice Address - Phone:509-946-1020
Practice Address - Fax:509-946-3062
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003238363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant