Provider Demographics
NPI:1023345667
Name:ALEN, KEVIN (AP)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:ALEN
Suffix:
Gender:M
Credentials:AP
Other - Prefix:MR
Other - First Name:DENNIS
Other - Middle Name:W
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6 PALM ROW
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4409
Mailing Address - Country:US
Mailing Address - Phone:904-824-9439
Mailing Address - Fax:
Practice Address - Street 1:2180 A1A S STE 104
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6523
Practice Address - Country:US
Practice Address - Phone:904-824-9439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00284171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist