Provider Demographics
NPI:1902932346
Name:BACOTE-ALLEYNE, MARSHA J (MSN, ARNP)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:J
Last Name:BACOTE-ALLEYNE
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6213 SW SOUTH POINTE DR STE 1A
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:KS
Mailing Address - Zip Code:66402-9001
Mailing Address - Country:US
Mailing Address - Phone:785-845-7743
Mailing Address - Fax:785-478-0329
Practice Address - Street 1:6213 SW SOUTH POINTE DR STE 1A
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:KS
Practice Address - Zip Code:66402-9001
Practice Address - Country:US
Practice Address - Phone:785-845-7743
Practice Address - Fax:785-478-0329
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-71779-071163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS160626Medicare UPIN