Provider Demographics
NPI:1144352295
Name:ALLEN, JEAN GAIL (CPNP)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:GAIL
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4707 BUCKINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-4261
Mailing Address - Country:US
Mailing Address - Phone:804-796-2300
Mailing Address - Fax:804-751-4815
Practice Address - Street 1:4707 BUCKINGHAM CT
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-4261
Practice Address - Country:US
Practice Address - Phone:804-796-2300
Practice Address - Fax:804-751-4815
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017000200363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics