Provider Demographics
NPI:1750959037
Name:ALLEN, JONATHAN DREW
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:DREW
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12005 SW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-7909
Mailing Address - Country:US
Mailing Address - Phone:918-734-7851
Mailing Address - Fax:
Practice Address - Street 1:5350 S WESTERN AVE STE 215
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4525
Practice Address - Country:US
Practice Address - Phone:405-605-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator