Provider Demographics
NPI:1952026494
Name:ALLRED, TAELYN RENEE'
Entity Type:Individual
Prefix:
First Name:TAELYN
Middle Name:RENEE'
Last Name:ALLRED
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 1:673 ARMSTRONG ST LOT 37
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2068
Mailing Address - Country:US
Mailing Address - Phone:567-241-2304
Mailing Address - Fax:
Practice Address - Street 1:673 ARMSTRONG ST LOT 37
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-2068
Practice Address - Country:US
Practice Address - Phone:567-241-2304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCKBLK7G8Q376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH73840892Medicaid