Provider Demographics
NPI:1801158886
Name:ALLEN, NICOLE (ACNP-BC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:NICOLE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17000 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3246
Mailing Address - Country:US
Mailing Address - Phone:225-752-2470
Mailing Address - Fax:225-646-5696
Practice Address - Street 1:17000 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3246
Practice Address - Country:US
Practice Address - Phone:225-752-2470
Practice Address - Fax:225-646-5696
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06811363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02675714Medicaid
LA2305191Medicaid
MS02675714Medicaid