Provider Demographics
NPI:1265078570
Name:ALLEN, PAULA NICOLE
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:NICOLE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-3101
Mailing Address - Country:US
Mailing Address - Phone:803-469-6990
Mailing Address - Fax:
Practice Address - Street 1:109 BARTON CREEK CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8027
Practice Address - Country:US
Practice Address - Phone:803-356-2286
Practice Address - Fax:803-419-8430
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23396363LG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology