Provider Demographics
NPI:1336203579
Name:ALLEN PEDIATRICS
Entity Type:Organization
Organization Name:ALLEN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARKSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-727-7334
Mailing Address - Street 1:1220 N ALMA DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4624
Mailing Address - Country:US
Mailing Address - Phone:972-727-7334
Mailing Address - Fax:972-727-1781
Practice Address - Street 1:1220 N ALMA DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4624
Practice Address - Country:US
Practice Address - Phone:972-727-7334
Practice Address - Fax:972-727-1781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0017208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB48590Medicare UPIN
TX8397J2Medicare ID - Type Unspecified