Provider Demographics
NPI:1477399004
Name:ALLEN, BUFFY (MSN, RN, LMT, CLT)
Entity type:Individual
Prefix:
First Name:BUFFY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSN, RN, LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 RANCH ROAD 261
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN DAM
Mailing Address - State:TX
Mailing Address - Zip Code:78609-4250
Mailing Address - Country:US
Mailing Address - Phone:512-694-9481
Mailing Address - Fax:
Practice Address - Street 1:111 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-3101
Practice Address - Country:US
Practice Address - Phone:512-694-9481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138179225700000X
TX653842163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist