Provider Demographics
NPI:1841270972
Name:ALLEN, MARY JANE (MSN, APRN, BC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 LENOX PARK BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-4299
Mailing Address - Country:US
Mailing Address - Phone:901-273-2368
Mailing Address - Fax:901-273-2351
Practice Address - Street 1:3150 LENOX PARK BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4299
Practice Address - Country:US
Practice Address - Phone:901-273-2368
Practice Address - Fax:901-273-2351
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006880363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3928988Medicaid
TN3928989Medicaid
TN4148068OtherBCBS OF TENNESSEE
TNP00365538OtherRAILROAD MEDICARE
TN4148068OtherBCBS OF TENNESSEE
TN3928988Medicaid
TN3928988Medicare PIN