Provider Demographics
NPI:1740549799
Name:ALLEN, ADAM WILLIAM (NP)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:WILLIAM
Last Name:ALLEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MARINERS PLAZA DR STE 504
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-6852
Mailing Address - Country:US
Mailing Address - Phone:985-246-1250
Mailing Address - Fax:985-246-1251
Practice Address - Street 1:2028 6TH ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3508
Practice Address - Country:US
Practice Address - Phone:504-417-3095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06833363LA2200X
LAAP06883363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health