Provider Demographics
NPI:1518506898
Name:ALLEN, ELAINE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 S HERITAGE WAY
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-9587
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:391 S HERITAGE WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-9587
Practice Address - Country:US
Practice Address - Phone:765-290-0763
Practice Address - Fax:765-393-3172
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28167768A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71009657BOtherCSR-PRESCRITPIVE AUTHORITY
IN71009657AOtherAPRN PRESCRITPIVE AUTHORITY