1518506898 NPI number — ELAINE ALLEN APRN, PMHNP-BC

Table of content: ELAINE ALLEN APRN, PMHNP-BC (NPI 1518506898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518506898 NPI number — ELAINE ALLEN APRN, PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
ELAINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518506898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
391 S HERITAGE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENDLETON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46064-9587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
391 S HERITAGE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENDLETON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46064-9587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-290-0763
Provider Business Practice Location Address Fax Number:
765-393-3172
Provider Enumeration Date:
01/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  28167768A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 71009657B . This is a "CSR-PRESCRITPIVE AUTHORITY" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 71009657A . This is a "APRN PRESCRITPIVE AUTHORITY" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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