Provider Demographics
NPI:1932103306
Name:ALLEN, AMBER L (MD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
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 40
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-0040
Mailing Address - Country:US
Mailing Address - Phone:606-633-4823
Mailing Address - Fax:606-633-1874
Practice Address - Street 1:132 VILLAGE CENTER RD
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831
Practice Address - Country:US
Practice Address - Phone:606-573-7771
Practice Address - Fax:606-573-2809
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY52968208000000X
IN01044178208000000X
TN65194208000000X
VA0101274672208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0114037Medicaid
IN200149370Medicaid
IN000000898560OtherANTHEM
IN200149370Medicaid