Provider Demographics
NPI:1669952644
Name:ALLEN, BOBBIE JEAN (APRN)
Entity type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:JEAN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BOBBIE
Other - Middle Name:JEAN
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336-7231
Mailing Address - Country:US
Mailing Address - Phone:606-723-7771
Mailing Address - Fax:
Practice Address - Street 1:1100 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-7231
Practice Address - Country:US
Practice Address - Phone:606-723-7747
Practice Address - Fax:606-726-9410
Is Sole Proprietor?:No
Enumeration Date:2018-08-18
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1138870163W00000X
KY3012600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse