Provider Demographics
NPI:1023224821
Name:ALLEN, JENNIE CARLENE (CNM)
Entity type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:CARLENE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:2365 GA HIGHWAY 18 W
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-4011
Mailing Address - Country:US
Mailing Address - Phone:478-986-1473
Mailing Address - Fax:478-986-1280
Practice Address - Street 1:2365 GA HIGHWAY 18 W
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-4011
Practice Address - Country:US
Practice Address - Phone:478-986-1473
Practice Address - Fax:478-986-1280
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN149998367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife