Provider Demographics
NPI:1770103392
Name:ALLEN, KRYSTEN DANIELLE
Entity type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:DANIELLE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-4647
Mailing Address - Country:US
Mailing Address - Phone:580-245-7101
Mailing Address - Fax:580-245-7102
Practice Address - Street 1:9 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-4647
Practice Address - Country:US
Practice Address - Phone:580-245-7101
Practice Address - Fax:580-245-7102
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator