Provider Demographics
NPI:1366746547
Name:ALLEN, NATHAN CARL (PA)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:CARL
Last Name:ALLEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15001 VIA MESSINA DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-9584
Mailing Address - Country:US
Mailing Address - Phone:661-872-9739
Mailing Address - Fax:
Practice Address - Street 1:9002 SEVENLEAF WAY
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-2229
Practice Address - Country:US
Practice Address - Phone:661-747-7015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23073363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant