Provider Demographics
NPI:1922674175
Name:VON KANNEL, ALLYSON TAYLOR (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:TAYLOR
Last Name:VON KANNEL
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 OLD CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9725
Mailing Address - Country:US
Mailing Address - Phone:803-520-9380
Mailing Address - Fax:803-520-5972
Practice Address - Street 1:424 OLD CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-6972
Practice Address - Country:US
Practice Address - Phone:800-352-0580
Practice Address - Fax:803-520-5801
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24981363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics